颅内宽颈动脉瘤的介入治疗

Endovascular Occlusion of Intracranial Wide - necked Aneurysms

介入治疗已成为颅内动脉瘤治疗的重要手段。电解可脱卸弹簧圈（GDC）栓塞颅内动脉瘤具有微创、安全、效果可靠的优点。但宽颈动脉瘤的致密栓塞率低,复发率高,如何提高颅内动脉瘤的致密栓塞率是该技术的要点和难点。动脉瘤微导管的双弯塑型、横向成篮、篮外填塞、分部填塞及瘤颈重塑型技术可明显提高动脉瘤的致密栓塞率。常见的并发症有术中出血、血栓栓塞、血管痉挛等,迅速继续填塞动脉瘤是处理术中出血最有效的措施;实施腰蛛网膜下腔持续引流,释放血性脑脊液,辅以抗凝及“3H”治疗是防治脑血管痉挛和血栓栓塞的的关键。对于特别宽颈及梭形动脉瘤,无法单纯采用GDC治疗,血管内支架结合GDC是治疗颅内梭形及宽颈动脉瘤的有效方法。正确的支架选择,防止支架移位,是手术成功的关键,但确切疗效需进一步长期随访。

Endovascular therapy, which is minimal invasive, safe and effective, has become one of the major treatment modalities for intracranial aneurysm. However, wide - necked aneurysms are difficult to occlude completely and the recurrence rate is high. So, dense packing of the aneurysms is the major point of this technique. The double - angled tip shaping, initial paralleled looping, out - basket packing, partially occlusion and remodeling techniques were extremely helpful.The major complications are hemorrhage during the operation, thromboembolic events and cerebral vasospasm.Continued coiling is the only effective treatment of choice for hemorrhage during operation. Continuous spinal cerebrospinal fluid drainage, anticoagulation and 3H therapy are important for the prevention and treatment of cerebral vasospasm. Endovascular stenting is by now the only valid choice of intervention for those extremely wide - necked and fusiform aneurysms that are not operable by GDC even with the help of balloon. Choice of appropriate stent, prevention of stent migration is crucial in this technique. The long - term results need further investigation.