颅内动脉瘤破裂早期的血管内栓塞治疗

Early endovascular embolization of ruptured intracranial aneurysms

目的探讨颅内动脉瘤破裂早期血管内栓塞治疗的效果。方法２０例破裂的颅内动脉瘤采取早期血管内治疗技术，用自制的多形钨丝弹簧圈栓塞动脉瘤囊。动脉瘤的位置：前交通动脉（ＡＣｏＡ）７例，后交通动脉（ＰＣｏＡ）６例，中动脉（ＭＣＡ）２例，眼动脉１例，后循环４例。病人分级：ＨｕｎｔＨｅｓＩＩ级３例，ＩＩ级及ＩＶ级各７例，Ｖ级３例。１６例于３天内治疗，其余４例于６天内治疗。结果１８例闭塞９０％以上，其中８例动脉瘤完全闭塞（４０％），２例死亡。术后观察３个月～２年，１５例效果良好，３例残留轻～中度瘫痪，术后随访无一例发生蛛网膜下腔出血（ＳＡＨ）。结论血管内栓塞是治疗颅内动脉瘤急性期破裂的较好方法。

Purpose To discuss the benefits of early endovascular embolization of emergent ruptured intracranial aneurysms. Methods Twenty cases were treated with self made multi form tungsten coil to embolize the aneurysmal sac .The sites of the aneurysms were ACoA 7 cases, PCoA 6 cases, MCA 2 cases, ophthal a 1 case and the posterior circulation 4 cases. Three cases were classified as Hunt Hess Grade II, 7 as Grade III, 7 as Grade IV, and 3 as Grade V. Results 16 of the 20 cases were treated within the first 3 days. Eight aneurysms were completely occluded (40%), 18 were more than 90% occluded, and two deaths. Clinical follow up was carried out at 3 months - 2 years,with good results in 15 cases, slight - moderate neurologic deficits in 3. There was no SAH after this treatment during clinical follow up. Conclusion Endovascular treatment is a good choice for the treatment of emergent ruptured intracranial aneurysms.