青少年颅内动脉瘤的影像学特征及治疗

Imaging features and treatment of intracranial aneurysms in adolescents :an analysis of 16 cases

目的探讨青少年颅内动脉瘤的影像学特征及治疗策略。方法对16例青少年(年龄为15～18岁;男10例,女6例)颅内动脉瘤的影像学特征、治疗方式及其结果进行回顾性分析。结果青少年颅内动脉瘤占同期颅内动脉瘤的0.9%。以蛛网膜下腔出血发病者8例,以肢体无力、动眼神经麻痹、外伤后鼻衄等发病者8例。共发现20个颅内动脉瘤,其中位于前循环15个,位于后循环5个;动脉瘤的部位:大脑中动脉5个,基底动脉及海绵窦内各3个,后交通动脉、脉络膜前动脉、颈内动脉各2个,眼动脉、大脑后动脉及椎动脉各1个。动脉瘤的直径<15mm者13个,≥15 mm者7个,其中 4个>25 mm,属于巨大动脉瘤。3例患者为多发动脉瘤。16例患者中,12例接受治疗:①介入治疗8例:其中5例行动脉瘤内栓塞术治疗,2例行载瘤动脉闭塞,1例海绵窦段颈内动脉假性动脉瘤行支架置入术;②显微外科手术治疗4例:其中2例行动脉瘤颈夹闭术,2例大脑中动脉复杂动脉瘤行颅内外动脉旁路移植后行动脉瘤孤立术。未治疗4例:1例治疗前载瘤动脉闭塞,动脉瘤自愈;术前动脉瘤再破裂死亡1例,2例因治疗风险巨大未行治疗。9例治疗患者经平均45个月的随访,均恢复良好(格拉斯哥预后量表评分为4～5分)结论①大脑中动脉是青少年颅内动脉瘤的好发部位;巨大型、外伤性、多发性、梭形动脉瘤比例较高;②青少年颅内动脉瘤治疗难度较大,部分病例需采用载瘤动脉闭塞或血管旁路移植术后孤立动脉瘤的方法进行治疗,预后较好;③青少年颅内动脉瘤的发病方式、影像学特征及治疗特点与儿童颅内动脉瘤相似,而与成人区别较大。

Objective To investigate the imaging features and therapeutic strategies of intracranial aneurysms in adolescents. Methods The imaging features, therapeutic strategies, and the outcome were analyzed retrospectively in 16 adolescents （ 10 males and 6 females） with intracranial aneurysms. Results Intracranial aneurysms in adolescents accounted for 0.9% of intracranial aneurysms at the same age period. Eight patients had subarachnoid hemorrhage; 8 had limb weakness, oculomotor palsy, and epistaxis. A total of 20 intracranial aneurysms in the 16 patients were found, including 15 at the anterior circulation and 5 at the posterior circulation, of them 5 aneurysms at the middle cerebral artery, 3 patients each at basilar artery and cavernous sinus, 2 patients each at posterior communicating artery, anterior choroidal artery and internal carotid artery, and 1 patient each at ophthalmic artery, posterior cerebral artery and vertebral artery. The diameter of aneurysms were 〈 15 mm in 13 and ≥ 15 mm in 7 aneurysms, 4 were giant aneurysms （ 〉25 mm） , 3 patients had multiple aneurysms. 12 of the 16 patients received the following treatments： ① 8 patients were treated with interventional methods, 5 of them were treated with aneurysm embolization, 2 were treated with parent artery occlusion, and 1 patient with pseudoaneurysm in cavernous segment of internal carotid artery was treated with stentting; ② 4 patients were treated with microsurgery, 2 of them were treated with aneurysm neck clipping, and the other 2 patients with complex middle cerebral artery aneurysms were treated with aneurysm trapping after extracranial-intracranial arterial bypass ; ③ 4 patients were not treated, the parent artery was occluded in one patient before the treatment, and the aneurysm was obliterated itself, one patient died of aneurysm rerupture before treatment, 2 patients were not treated because of high risks of any treatment. 9 treated patients were followed up for an average of 45 months, and they all recovered well （ GOS 4 - 5 ）. Conclusions ① The middle cerebral artery is the predilection site of intracranial aneurysms in adolescents; the occurence of the giant, traumatic, multiple, and fusiform aneurysms is common. ② Intracranial aneurysms in adolescents are more difficult to treat. Some cases need to be treated with aneurysm trapping after parent artery occlusion or bypass, but their prognosis is favorable. ③The onset mode, imaging features, and treatment strategies of intracranial aneurysms in adolescents are similar to those in children, but more different in adult patients.