创伤性颅内动脉瘤的诊治经验

Experiences of diagnosis and treatment of traumatic aneurysm

目的探讨创伤性颅内动脉瘤的诊断、治疗方式的选择。方法回顾性分析本科室收治的17例创伤性颅内动脉瘤的资料。17例患者中15例有颅脑外伤史,2例有颅脑手术史,所有患者均行脑血管造影检查,6例采取开颅手术,11例采取血管内栓塞治疗,观察治疗效果并采用格拉斯哥结果评分(Glasgow outcome scale,GOS评分)进行术后随访。结果 17例患者经采用开颅手术或血管内栓塞后均获得成功,随访12例患者(3个月至12年)GOS评分5分8例,4分2例,1分2例。结论创伤性颅内动脉瘤是颅脑外伤及颅脑手术的少见并发症,但破裂出血后的死残率极高。提高对创伤性颅内动脉瘤的认识,特别是提高医源性动脉瘤的认识,早期发现,选择合适的治疗方式,可获得较好治疗效果。

Objective To discuss diagnosis and therapies of traumatic aneurysm and prevention of the complications. Methods Data of 17 patients diagnosed as traumatic aneurysm were retrospectively analyzed. Fifteen patients had craniocerebral trauma history while the other two had history of craniocerebral surgery. All the patients were given digital subtraction angiography（ DSA）. Six patients received craniotomy while the others received endovascular therapies. The efficacy of the treatments was observed and postoperative follow-up were performed using the Glasgow outcome scale（ GOS）. Results All of the 17 patients had successful treatments. Twelve patients were followed up from 3 months to 12 years while the other 5 cases were lost by some reasons. The final clinical outcome evaluated by GOS value was 5 in 8 cases,4 in 2 cases,and 2 in 1 case. Conclusion Traumatic aneurysm is a rare complication of craniocerebral trauma or craniocerebral surgery. The ruptured traumatic aneurysm results in high mortality. Improving the awareness of traumatic aneurysm,especially the iatrogenic aneurysm,early diagnosis and choosing proper treatment help achieve relatively good therapeutic effects.