颅内微型动脉瘤诊断和治疗的临床研究

Diagnosis and Treatment of Intracranial Blister-like Aneurysms

目的探讨颅内微型动脉瘤的临床特征和治疗方法。方法经DSA确诊的颅内微型动脉瘤(直径<3 mm)21例(22枚)中,1例放弃外科治疗;9例行开颅手术,其中动脉瘤夹闭5例,包裹3例(1例电凝动脉瘤后动脉瘤消失),孤立载瘤动脉(颈内动脉)1例;11例行血管内治疗,其中1例小脑上动脉瘤采用NBCA胶栓塞,10例(11枚动脉瘤)采用微弹簧圈栓塞,其中采用瘤颈成型技术6例(支架辅助2例,双导管技术3例,导丝辅助技术1例)。结果行开颅手术的9例中,死亡1例,治愈4例,好转2例,残废2例;术中动脉瘤破裂2例。行血管内治疗手术的11例中,死亡1例,治愈7例,好转1例,残废2例。血管内栓塞术中动脉瘤破裂2例。结论3D-DSA是诊断颅内微型动脉瘤最有价值的方法,手术和栓塞治疗的风险均较高,但采用适当的技术仍可以取得好的效果。

Objective To explore the methods to diagnose and treat intracranial blister-like aneurysms. Methods Twenty-two intracranial blister-like aneurysms （less than 3 mm in diameter） were definitely diagnosed as by DSA in 21 patients, of whom, 1 refused surgical treatment, 9 underwent microsurgery and 11 endovascular embolization. Results In 9 patients undergoing microsurgery, 5 aneurysms were clipped, 3 were enwrapped and 1 was treated by clipped the parent artery and aneurysm. In 2 patients undergoing microsurgery, the aneurysms ruptured during the operation. Of 9 patients undergoing the microsurgery, 4 were cured, 2 improved, 2 disabled and 1 died. Of 11 patients with 12 aneurysms undergoing endovascular embolization with NBCA glue （1 patient） and coils （10 patients with 11 aneurysms）, 7 were cured, 1 improved, 2 disabled and 1 died. The aneurysms ruptured during endovascular embolization with coils in 2 patients. Conclusions Three-dimensional DSA is a good method to diagnose the intracranial blister-like aneurysms. The treatment of intracranial blister-like aneurysms by the micresurgery or endovascular embolization is of certain risk, but good outcomes may be obtained in most of the patients with intracranial aneurysms by skillful technique.