颅内微小动脉瘤栓塞治疗

Endovascular treatment of very small intracranial aneurysms

目的探讨颅内微小动脉瘤的血管内介入栓塞不同方法的可行性和疗效。方法回顾分析收治686例颅内动脉瘤患者中的微小动脉瘤43例（51个动脉瘤），男19例、女24例，多发动脉瘤5例。采用单纯弹簧圈栓塞、支架辅助弹簧圈栓塞和Onyx胶栓塞的神经介入技术进行进行治疗并得到随访。结果51个动脉瘤中27个单纯用弹簧圈栓塞，9个采取支架辅助弹簧圈栓塞，3个仅在载瘤动脉内放置支架，12个采用Onyx胶栓塞。除了3个未破裂动脉瘤只在载瘤动脉放置支架外，30个动脉瘤0级栓塞，11个Ⅰ级栓塞，7个Ⅱ级栓塞。1例术中急性血栓形成，尿激酶溶栓后再通；1例手术中破裂出血，术后昏迷，经治疗后GOS评分4分；3例术后血管痉挛出现一过性轻偏瘫。所有患者临床随访平均40．6个月（3—72个月），1例再出血，其中36例复查血管造影，未见再复发，1例弹簧圈部分脱出至载瘤动脉。结论颅内微小动脉瘤的准确诊断需要高排数的CTA或（和）3D—DSA；介入栓塞是治疗颅内微小动脉瘤有效的方法之一，位于4级以远的微小动脉瘤可以采用Onyx胶栓塞，其远期效果还有待于进一步随访总结。

Objective To study the feasibility and efficacy of different endovascular embolization methods for the treatment of very small intracranial aneurysms. Methods A retrospective analysis was made on the basis of the clinical data of 43 patients with very small intracranial aneurysms （51 lesions） from 686 cases of patients with intracranial aneurysms. There were 19 male cases and 24 female. Among them, 5 cases were multiple aneurysms. Endovascular interventional treatments, such as simple coil embolization, stent - assisted coil embolization and Onyx glue embolization, were performed. All patients were followed -up. Results In 51 aneurysm lesions, 27 received simple coil embolization, 9 stent- assisted coil embolization, 3 simple stent placement within the parent artery and 12 Onyx glue embolization. In these cases, except 3 lesions with simple stentt placement within the parent artery, 30 aneurysms to grade zero embolism,ll to grade Ⅰ,7 to grade Ⅱ. 1 patient had acute thrombosis and received urokinase thrombolytic recanalization. 1 patient had intraoperative bleeding and postoperative coma, and got 4 of GOS score after treatment. The postoperative vasospasm was observed in 3 cases and transient hemiplegia occurred. All patients were followed - up for an average of 40. 6 months （3 -72 months）. Rebleeding occurred in 1 patient 36 cases underwent reexamination of angiography and had no recurrence. In 1 case, the coils partially prolapsed to the parent artery. Conclusions The accurate diagnosis of mirco - intracranial aneurysms requires high rows of CTA and/or 3D - DSA. The endovascular treatment is effective for the treatment. For those mirco - intracranial aneurysms which locate beyond stage Ⅳ, Onyx glue aneurysm embolization is recommended, but its long - term effect still needs further follow - up for more accurate conclusions.