颅内未破裂动脉瘤随访期间发生破裂的临床观察

Clinical observation of ruptures of intracranial aneurysms during the follow-up period

目的 观察颅内未破裂动脉瘤随访期间发生破裂的可能原因.方法 回顾性分析南昌大学第一附属医院神经外科2015年1月至2017年1月收治的4例随访期间动脉瘤破裂患者的临床及影像学资料,结合文献分析与破裂相关的可能原因.结果 4例患者中,男2例,女2例,年龄为52～76岁,2例有原发性高血压,2例为多发动脉瘤.4例中,责任动脉瘤未破裂时最大直径均＜7 mm,3例合并子瘤,2例动脉瘤破裂后较破裂前有生长.开颅夹闭1例（完全夹闭）,血管内治疗3例（1例完全栓塞,2例近全栓塞）.术后患者均恢复良好.结论 高龄、高血压、多发动脉瘤、形态不规则等因素可能是动脉瘤破裂的危险因素,应给予积极治疗.

Objective To determine possible causes of ruptures of intracranial aneurysms during the follow-up period.Methods There were a total of 183 cases of unruptured intracranial aneurysms （UIAs） diagnosed between January 2015 and January 2017 at Department of Neurosurgery,the First Affiliated Hospital of Nanchang University.Among them,aneurysm rupture occurred in 4 patients （2.2％） during follow-up,whose clinical and imaging data were retrospectively analyzed.The risk factors of aneurysm rupture were investigated with relative literatures as references.Results Mean age of the 4 patients,including 2 males and 2 females,was 60.5 years.Two patients had medical history of high blood pressure.Multiple aneurysms were found in 2 cases.The sizes of UIAs in this series were all less than 7 mm.The daughter sac was found in 3 UIAs and the growth of aneurysm was observed in 2 patients after rupture.One case underwent complete surgical clipping and the other 3 were received endovascular treatment （complete occlusion in 1 and near-complete occlusion in 2）.Post-operative outcomes were favorable in all cases.Conclusion The risk factors for rupture of UIAs might include older age,hypertension,multiple aneurysms and irregular shape,which should be well treated.