血管内栓塞治疗大脑中动脉动脉瘤的疗效及安全性研究

Efficacy and Safety of Endovascular Embolization Treatment of Middle Cerebral Artery Aneurysms

目的探讨血管内栓塞治疗大脑中动脉动脉瘤的可行性、有效性和安全性。方法选取河北医科大学第一医院神经外科2005年6月—2013年10月采用血管内栓塞治疗的65例大脑中动脉动脉瘤患者,采用单纯弹簧圈栓塞术21例,球囊辅助弹簧圈栓塞术15例,支架辅助弹簧圈栓塞术12例,单纯支架置入术17例。回顾性分析65例患者的影像学资料,动脉瘤部位、治疗方法及结果,手术并发症,术后3个月进行随访。采用改良Rankin评分(mRS)衡量患者神经功能恢复状况。结果 65例大脑中动脉动脉瘤患者中,大脑中动脉M1段动脉瘤患者43例,大脑中动脉分叉部动脉瘤患者22例。12例为未破裂动脉瘤,颅脑CT显示为侧裂区类圆形高密度影;53例为破裂动脉瘤,颅脑CT表现均为典型的蛛网膜下腔出血。采用血管内栓塞治疗均获成功。术后即刻造影,动脉瘤瘤颈显影5例,瘤体显影14例,致密栓塞46例。无围术期死亡病例。并发症4例,1例术中破裂,迅速完全栓塞动脉瘤后患者无相关症状;其中1例术后3 d出现一过性肢体无力;1例术后1周动脉瘤再破裂出血,经手术清血肿治疗后好转;1例大脑中动脉分叉处动脉瘤球囊辅助栓塞后4 d出现脑梗死。42例患者术后3个月行数字减影血管造影(DSA)检查,其中15例动脉瘤进展,再次栓塞治疗;27例无进展。3个月随防时mRS 0分45例,1分14例,2分4例,4分2例。结论血管内栓塞治疗大脑中动脉动脉瘤是一种安全、有效的方法。

Objective To investigate the feasibility,effectiveness and safety of endovascular embolization treatment of middle cerebral artery aneurysms. Methods 65 patients with middle cerebral artery aneurysm treated by endovascular embolization in Department of Neurosurgery,the First Hospital of Hebei Medical University between June 2005 and October 2013 were enrolled,including 21 subjects by simply embolization with coils,15 by balloon assisted remodeling technique and coils,12 by embolization with stents and coils and 17 by simply implantation of stents. Their imaging data,aneurysm site,treatment method and result,operative complications,follow- up 3 months after operation were analyzed retrospectively. A modified Rankin Scale was used both for recovery measurement of patients＇ nerve function. Results 65 cases of cerebral artery aneurysms,43 aneurysms located in the M1 segment,22 in the middle cerebral artery bifurcation; 12 patients had unruptured aneurysms and cerebral and CT scan showed circular high density in lateral fissure area while 53 patients had ruptured aneurysms manifested as typical subarachnoid hemorrhage under CT scan. Endovascular embolization operation was successful in all patients. Immediate postoperative angiography showed dense embolism in 46 cases,5 cases of developing cervical tumors and 14 cases of tumor development. No cases died during peri- operative period. 4 had complications and 1 underwent intraoperative rupture. After quickly complete embolization of aneurysm therapy,the relevant symptoms of the patients disappeared; 1 case had a transient weakness after three days; 1 case underwent rapture again one week after operation and improved after treatment by surgical debridement; 1case with aneurysms located in MCA had cerebral infarction 4 days after balloon- assisted embolization. DSA check 3 months after operation showed that progress in 15 cases receiving embolization treatment again; 27 patients no progress. MRS score was 0 in 45 cases,1 in 14 cases,2 in 4 cases,4 in 2 cases at follow- up after 3 months. Conclusion Endovascular embolization treatment of cerebral aneurysms is a safe and effective method.