Onyx闭塞载瘤动脉治疗颅内远端动脉瘤的随访分析

Parent artery occlusion with Onyx for the treatment of distal intracranial aneurysms:a followup analysis

目的探讨液态栓塞剂Onyx闭塞载瘤动脉治疗颅内远端动脉瘤的效果。方法回顾性分析27例破裂动脉瘤患者（共29个颅内远端动脉瘤）的临床资料。动脉瘤位于小脑后下动脉17个，小脑前下动脉3个，小脑上动脉2个，大脑后动脉2个，大脑前动脉1个，大脑中动脉4个。对28个动脉瘤采用Onyx闭塞近端载瘤动脉及动脉瘤的方式治疗，1个大脑中动脉远端动脉瘤自行闭塞。结果所有治疗动脉瘤均完全闭塞。1例患者因术中出血死亡，其余患者术后随访8—67个月。23例患者最终格拉斯哥预后评分（GOS）为5分，3例为4分；17例患者术后DSA随访，5例患者术后CTA随访，动脉瘤均无复发；4例患者临床随访。所有幸存患者未见新的神经功能异常，无再出血。结论中长期随访结果显示，Onyx闭塞载瘤动脉及动脉瘤治疗颅内远端动脉瘤临床疗效满意，复发率低。

Objective To investigate the effect of parent artery occlusion with liquid embolic agents （Onyx） for the treatment of distal intracranial aneurysms. Methods The clinical data of 27 patients with 29 ruptured distal intracranial aneurysms were analyzed retrospectively. Seventeen aneurysms located in the posterior inferior cerebellar artery,3 in the anterior inferior eerebellar artery,2 in the superior cerebellar artery,2 in the posterior cerebral artery, 1 in the anterior cerebral artery, and 4 in the middle cerebral artery. Twenty-eight aneurysms were treated with Onyx to occlude proximal parent arteries and aneurysms, and 1 distal middle cerebral artery aneurysm was occluded spontaneously. Results All the aneurysms treated were occluded completely. One patient died of intraoperative hemorrhage. The remaining patients were followed up for 8 to 67 months. The final Glasgow outcome scale （GOS） scores were 5 in 23 patients and 4 in 3 patients. 17 patients were followed up with digital subtraction angiography （DSA） and 5 were followed up with computed tomography angiography （CTA） after procedure. There was no recurrence of the aneurysm. Four patients were followed up clinically. No new neurological disturbance or rebleeding was found in all the survived patients. Conclusion Medium-long term follow-up results have shown that the clinical efficacy of proximal parent artery occlusion with Onyx for the treatment of distal intracranial aneurysms is satisfactory, and the recurrence rate is low.