颅内巨大动脉瘤诊断及治疗

The diagnosis and treatment of giant intracranial aneurysm

目的颅内巨大动脉瘤占颅内动脉瘤的5％－7％，有人报告可达到20％以上。由于部位深，周围结构复杂，以及瘤颈难以处理等因素，治疗较困难。本文报告巨大动脉瘤36例，占我院同期收治的动脉瘤6.6％（36／547）。方法血管内栓塞21例，手术夹闭或切除7例，载瘤动脉栓塞3例，保守治疗5例。结果血管内栓塞21例，其中完全栓塞3例，栓塞80％以上者（含完全栓塞）15例，余6例不足80％，死亡2例。手术夹闭或切除者7例，重残及死亡各1例。保守治疗组1例造影后破裂死亡.结论21例血管内治疗，尽管大多数病例（71．4％）仅栓塞80％，但近期效果较好。对深部位及危重的巨大动脉瘤病人，可考虑采用血管内治疗方法，但考虑血管内治疗历史短，危险性及尚未完全验证的功效，必须长期随访。

Objective There are 36 cases of giant aneurysms in this report, that is 6.6%(36/547) in the all aneurysms treated duringthe same period in our hospital. There are 5%-7% intraeranial aneurysm are giant, and it was reported that the percentage is 20%by someone.Because its location is deep,surrounding structure is complicated, and it is difficult to deal with the neck, we have someproblem to treat it. Method 21 cases were treated hy endovascular embolization, 7 cases were cliped or removed by operation, 3cases were occluded in the parent artery, 5 cases were treated by conservative method. Result In 21 cases endovascular embolization,there were 3 cases embolized completely, 15 cases embolized more than 80%, 6 cases less than 80%, and 2 dead. 7 eases wereelipped or removed by operation, 1 case died and 1 case was morhid seriously,and 1 case died because aneurysm ruptured duringconventional treatment. Conclusion In this group of 21 cases endovascular treatments, although most of them (71.4%) were embolizedonly 80%, the short time effect is quite good. Endovascular treatment could he selected for the patients who have a deep-locationedor giant aneurysm. Considering the short history of endovascular treatment, and its risk and effect have not been proved perfectly,Its evaluation needs a long-period follow up.