复发性颅内动脉瘤的治疗探讨

Treatment of recurrent intracranial aneurysms

目的探讨复发性颅内动脉瘤的复发机制及治疗方法。方法对我科1997～2004年间行动脉瘤夹闭术或血管内介入治疗后复发的18例动脉瘤患者（前循环动脉瘤13例，后循环动脉瘤5例）的临床表现、影像学资料进行综合分析，建立个体化治疗方案，其中15例患者行再次血管内介入治疗，4例宽颈动脉瘤辅以颅内支架，3例行手术夹闭。结果15例行血管内介入治疗患者均栓塞良好，3例手术完全夹闭。术后1例死亡，2例偏瘫，15例恢复满意。结论针对不同情况的复发性动脉瘤患者实施个体化治疗方案。分别进行手术夹闭、血管内介入或联合治疗可提高患者生存质量。

Objective To explore recurrent mechanism and combined treatment for the patients with recurrent intracranial aneurysms. Methods Clinical manifestations and image data of 18 patients with intracranial aneurysms （13 anterior and 5 posterior communicating artery aneurysms） who were treated with aneurysm clipping or endovascular interventional therapy from 1997 to 2004 were comprehensively analyzed to establish individual combined treatment strategies. In the 18 recurrent cases, 15 underwent again endovascular embolotherapy, 4 were implanted intracranial stent due to wide-necked aneurysm, and 3 received clipping operation. Results Intravascular embolotherapy and clipping operation were both successful in these patients. All cases achieved satisfactory recovery except that 1 case died and 2 suffered from hemiplegia. Conclusions The combined treatment strategies based on individual characteristics of current aneurysms, such as surgical clipping, endovascular therapy combined with stenting, can improve post-operative quality of patients＇ life and decrease mortality.