血管内栓塞治疗颅内动脉瘤

Endovascular embolization treatment for intracranial aneurysm

目的探讨经血管内栓塞治疗颅内动脉瘤的手术方法和操作技巧。方法回顾分析1999年10月至2006年10月问栓塞治疗的175例病人,181个动脉瘤的方法和效果。181个动脉瘤中,破裂动脉瘤163个,未破裂动脉瘤18个。按Hunt-Hess分级:0级18例,Ⅰ级16例,Ⅱ级57例,Ⅲ级46例,Ⅳ级30例,Ⅴ级8例。结果181个动脉瘤,使用弹簧圈栓塞172个,其中单纯弹簧圈栓塞101个,支架结合弹簧圈栓塞40个,球囊辅助弹簧圈栓塞28个,双导管技术结合弹簧圈栓塞动脉瘤3个;单纯支架栓塞9个。其中165个动脉瘤达到致密栓塞,无瘤颈残留,大部分栓塞7例,9个单纯支架栓塞的动脉瘤术后造影均有不同程度的显影,但显影明显变淡。术后恢复良好169例,重残2例,死亡4例。结论血管内栓塞治疗颅内动脉瘤是安全有效的,病人和手术时机的选择以及手术技巧的掌握,是决定手术成功的关键因素。

Objective To evaluate the operative method and skill of endovascular embolization treatment of intracranial aneurysm. Methods The methods and results of 175 cases of patients with 181 intracranial aneurysms treated endovascularly from October 1999 to October 2006 were analyzed retrospectively. Results Of 181 aneurysms, 101 aneurysms were treated with only coils, 40 aneurysms with stent-assisted coiling, 28 aneurysms with balloon-assisted coiling, 9 aneurysms with only stenting, 3 aneurysms with double catheters technigue. For 172 aneurysms treated with coiling, 165 aneurysms were completely occluded, 7 aneurysms were embolized partially, Four patients died and another 2 cases were severely disabled. Conclusion Endovascular embolization treatment is a safe and effective method for intracranial aneurysm. The selection of patient and timing of treatment are major factor for technical success.