血管内栓塞治疗多发性颅内动脉瘤

Endovascular Embolization of Multiple Intracranial Aneurysms

目的评价血管内栓塞治疗多发性颅内动脉瘤的安全性与有效性。方法回顾性分析经血管内栓塞治疗16例多发性颅内动脉瘤(共38个动脉瘤)患者的临床资料。36个动脉瘤在前循环,2例病人分别有1个动脉瘤在后循环。根据Hunt-Hess评分,Ⅰ级5例,Ⅱ级6例,Ⅲ级3例,Ⅳ级2例。结果15例病人一次性将所有动脉瘤栓塞,1例仅栓塞责任动脉瘤,未能栓塞的动脉瘤二期手术夹闭。无死亡病例,临床随访6个月以上,所有病例无再出血;预后按GOS评分,良好11例,轻残3例,重残1例,植物生存1例。结论血管内栓塞治疗多发性颅内动脉瘤是安全有效的。诊断明确后应尽早治疗责任动脉瘤;然后再根据未破裂动脉瘤的处理原则,选择性栓塞其它未破裂动脉瘤。

Objective To explore the safety and efficacy of endovascular treatment of multiple intracranial aneurysms （MIA）. Methods The clinical and imaging data of 16 patients with MIA who underwent endovascular embolization were analyzed retrospectively. Of 38 intracranial aneurysms in the 16 patients, 36 were in the anterior circulation, 2 were in the posterior circulation. The disease conditions in 5 patients belonged in Hunt-Hess grade Ⅰ , in 6 patients in grade Ⅱ, in 3 patients in grade III and in 2 patients in grade Ⅳ. Results A total of 37 aneurysms in 16 patients were successfully embolized. In 1 patient with 2 aneurysms, only the aneurysm which produced subarachnoid hemorrhage was embolized and the other aneurysm was clipped by craniotomy. Of 16 patients, 11 were recovered well, 3 moderately disabled, 1 severely disabled, and 1 vegetably survived according to GOS. There was no rebleeding in all the patients during follow-up for over 6 months. Conclusions The endovascular embolization is a safe and effective method to treat MIA. The ruptured aneurysm should be treated by surgery as soon as possible, but the unruptured aneurysms should be selectively treated according to Guidelines for the surgical treatment of unruptured intracranial aneurysms.