颅内多发动脉瘤的3D-CTA诊断及手术治疗

3D-CTA diagnosis and surgical treatment of multiple intracranial aneurysms

目的探讨颅内多发动脉瘤的3D-CTA诊断价值和开颅动脉瘤颈夹闭和(或)血管内栓塞治疗效果。方法回顾性分析39例经3D-CTA确诊的颅内多发动脉瘤临床资料,36例采用开颅动脉瘤颈夹闭和/或血管内栓塞治疗,一期单侧翼点入路开颅动脉瘤颈夹闭术18例,双侧翼点或翼点+前纵裂入路动脉瘤颈夹闭术6例;二期开颅动脉瘤颈夹闭术3例;开颅动脉瘤颈夹闭术+血管内栓塞术4例;单纯血管内栓塞术5例。手术夹闭动脉瘤颈64个,血管内栓塞14个,11个动脉瘤未予处理。结果39例共发现动脉瘤89个,其中2个动脉瘤30例,3个动脉瘤7例,4个动脉瘤2例;31例术后复查3D-CTA,其中30例显示动脉瘤夹闭良好或完全栓塞,1例动脉瘤颈夹闭不全术后一个月动脉瘤再次破裂出血,再次开颅手术夹闭,痊愈出院,随访3个月至7年,按GOS预后分级,良好29例,轻残5例,重残2例,死亡3例均因动脉瘤再次破裂未处理。结论3D-CTA可靠、快捷、安全,可作为颅内多发动脉瘤的首选诊断方法,开颅动脉瘤颈夹闭和/或血管内栓塞治疗效果良好。

Objective To explore the diagnostic value of 3D-CTA for multiple intracranial aneurysms and surgical effect of clipping and endovascular embolization. Methods The clinical data of 39 cases of multiple intracranial aneurysms which were all diagnosed by 3D-CTA were analyzed retrospectively. A total of 36 cases were treated with surgical clipping or endovascular embolization, including one-stage surgical clipping in 18 cases through unilateral pterional approach, 6 cases through bilateral pterional approach/pterional approach and anterior longitudinal fissure approach; two-stage surgical clipping in 3 cases; surgical clipping and endovascular embolization in 4 cases; endovascular embolization in 5 cases. Totally, surgical clipping achieved in 64 cases, endovascular embolization in 14 cases, and no treatment in 11 cases. Results A total of 89 aneurysms were found in 39 cases, including 2 aneurysms in 30 cases, 3 aneurysms in 7 cases, and 4 aneurysms in 2 cases. Postoperative 3D-CTA was conducted in 31 cases. Thirty cases were well-clipped or completely embolized and 1 case underwent another surgical clipping because of re-bleeding one month after incomplete clipping, who got recovery when discharged from hospital. According to GOS prognosis grading, good prognosis was got in 29 cases, slight disability in 5 cases, severe disability in 2 cases, and death in 3 cases because of re-bleeding of aneurysms. Conclusion 3D-CTA is a reliable, quick and safe diagnostic choice in multiple intracranial aneurysms. Surgical clipping and endovascular embolization can achieve good effect.