大脑中动脉动脉瘤治疗111例报告

Report of 111 cases of middle cerebral artery aneurysm

目的探讨大脑中动脉动脉瘤治疗方法和疗效。方法回顾性分析2005年1月至2011年7月间手术夹例和血管内介入治疗的111例114个大脑中动脉动脉瘤。分析术前分级、动脉瘤夫小、部位、治疗结果。结果于术夹闭88例患者90个动脉瘤，术后15d-48个月（平均12．7个月）造影随访，夹闭动脉瘤89个，瘤颈残留1个，末见复发。血管内介入治疗23例24个动脉瘤。支架辅助栓塞7个，球囊辅助栓塞3个，单纯微弹簧圈栓塞12个，17个动脉瘤术后1—37个月（平均10．6个月）造影随访，5个（29．4％）复发；单纯支架治疗2个（未破裂夹层动脉瘤），术后3个月造影随访，1个动脉瘤消失，1个无变化。格拉斯哥预后评分（GOS）5～4分中夹闭72例（81．8％），介入21例（91．3％）。结论窄颈（浆果样）大脑中动脉动脉瘤，手术夹闭和介入栓塞均不易复发。复杂大脑中动脉动脉瘤手术夹闭不易复发，介入栓塞相对容易复发。大脑中动脉动脉瘤合并血肿（血肿量〉30ml），选择手术夹闭并清除血肿。介入栓塞和手术夹闭大脑中动脉动脉瘤均能有效防止动脉瘤再出血。

Objective To discuss the choice and efi＇ectiveness of treatment of middle cerebral artery aneurysms（ MCAA ）. Methods Analyzed 111 patients with a total of 114 MCAA who underwent surgical clipping and endovaseular treatment. Some factors were reviewed ： Hunt - Hess grade, aneurysm size,location morphology, clinical outeomes. Results The following- up results （mean 12. 7 months ） showed that 89 aneurysms were elpping completely and residual neck was in 1. There were no angiographic recurrence in all aneurysms. 7 ruptured aneurysms treated with stent- assisted,3 with balloon- assisted, 12 with coil alone. The following - up results （ mean 10. 6 months） showed that 5 were recurrence in 17 aneurysms. 2 unruptured dissecting aneurysms were treated with stent alone. I was occluded completely. Good outcome （ Glasgow Outcome Score = 445 ） were 81.8% （72 patients）in clipping group and 91.3% （21 patients） in endovaseular treatment group. Conclusions ＂ Berry＂ MCAA is suitable for both surgical clipping and endovaseular treatment. Surgical clipping should he considered in MCAA with hematoma （volume of hematoma 〉 30 ml）. Lower recurrence was associated with surgical clipping, but more higher recurrence with endovascular treatment in complex MCAA. Endovascular treatment and surgical clipping can prevent MCAA rebleeding effectively.