以假性成分为主的“葫芦状”动脉瘤的影像学特点与治疗策略

Intracranial lageniform aneurysms:imaging features,diagnosis and treatment strategies

目的探讨假性成分为主的"葫芦状"动脉瘤的影像学特点、诊断与治疗策略。方法回顾性分析6例颅内真性动脉瘤-假性动脉瘤复合体患者的临床资料。结果本组6例CT提示蛛网膜下腔出血,伴有脑实质内血肿。数字减影血管成像(digitalsubtraction angiography,DSA)或者磁共振血管成像检查提示颅内动脉瘤,5例前交通动脉瘤,1例左侧大脑中动脉瘤;3D-DSA重建提示动脉瘤由大、小两部分构成,均为小母囊上发出较大的子囊。本组5例前交通动脉瘤均行弹簧圈栓塞术,2例术后出现严重脑组织肿胀,1例急诊行去骨瓣减压及动脉瘤夹闭术后逐渐恢复,1例死亡;大脑中动脉瘤行开颅夹闭术。2例开颅手术患者术后病理均提示假性动脉瘤成分。5例出院患者预后良好,均随访3个月,临床症状稳定。结论葫芦状动脉瘤是一种以假性动脉瘤成分为主的特殊形态的动脉瘤复合体,有其独特的病理生理过程和影像学特点,治疗上强调根据个体情况及动脉瘤形态学特点选择最佳治疗方法尽早修复动脉瘤。

Objective To explore the imaging features, diagnosis and treatment strategies of intracranial lageniform aneurysms. Methods The clinical characteristics and therapeutic outcomes of 6 patients with intracranial lageniform aneurysms were retrospectively analyzed. Results All the 6 aneurysms, including 5 anterior communicating artery aneurysms and 1 middle cerebral artery （MCA） aneurysm, were diagnosed by CT, DSA and （or） MRA. Pretreatment CT revealed subarachnoid hemorrhage and intracranial hematoma surrounding the ruptured aneurysm. Three dimensional DSA showed that all the lageniform aneurysms contained two parts, the larger false aneurysm and the smaller true aneurysms. All the 5 Acom aneurysms were coiled and the MCA aneurysm was clipped. Two patients with coiling developed serious brain edema, and acute decompressive craniectomy was performed to 1 of them. Pathological examination of the surgical specimens confirmed that pseudoaneurysm formed the larger part of the lageniform aneurysm. One patient died of brain hernia, and the other 5 patients were discharged with good GOS. All the patients showed stable neurological status during the 3-month follow-up. Conclusion Lageniform aneurysm is a complex aneurysm consisting in larger part of false aneurysm and in smaller part of true aneurvsm, and early intervention with individualized sur~：eries is recommended.