颅内动脉瘤手术和血管内治疗的适应证和疗效分析

Analysis of Indication and Outcome between Microsurgical and Endovascular Therapy for Patients with Intracranial Aneurysms.

目的 :探讨颅内动脉瘤手术治疗和血管内治疗各自的适应证、优缺点和治疗效果。方法 :回顾性分析我科自1 994年 6月至 2 0 0 1年 7月收治颅内动脉瘤 2 78例 ,其中手术治疗 1 73例 ,血管内治疗 1 0 5例。手术治疗组包括前交通动脉瘤 (AcoAA) 65例 ,后交通动脉瘤 (PcoAA) 60例 ,大脑中动脉瘤 (MCAA) 2 0例 ,颈内动脉瘤 (ICAA) 2 0例 ,胼周动脉瘤 (ACAA) 2例 ,后组循环动脉瘤 8例。血管内治疗组采用机械可控式弹簧圈 (MDS)或电解可控式弹簧圈 (GDC)栓塞疗法 ,栓塞的动脉瘤包括AcoAA 2 2例 ,PcoAA 42例 ,MCAA 1 3例 ,ICAA 9例 ,后组循环动脉瘤 4例。采用球囊闭塞颈内动脉治疗颈内动脉海绵窦段巨大动脉瘤 2 5例。结果 :手术治疗组出院时治疗结果为优者1 57例 (90 .8% ) ,中度残疾 5例 (2 .9% ) ,重度残疾 4例 (2 .3 % ) ,死亡 9例 (5 .2 % ) ,其中I、II级病人无死亡。血管内治疗组出院时治疗结果为优者 96例 (91 .4 % ) ,中度残疾 1例 (1 .0 % ) ,重度残疾 4例 (3 .8% ) ,死亡 4例 (3 .8% )。结论 :血管内治疗和显微外科治疗同属微侵袭治疗范畴 ,各自有其优缺点。对于大部分颅内动脉瘤来讲 ,二种方法均可选用 ,并可取得良好效果。

To analyze respective indication, outcome, mertis and shortcomings of intracranial aneurysms managed by microsurgical or endovascular therapy.Methods: 278 cases of intracranial aneurysms treated in Ruijin Hospital from June 1994 to July 2001 were included in this study. Among of them, 173 cases were subjected to microsurgical therapy while 105 cases were subjected to endovascular therapy. In operative group, there were 65 cases of anterior communicating artery aneurysms(AcoAA), 60 cases of posterior communicating artery aneurysms(PcoAA), 20 cases of middle cerebral artery aneurysms(MCAA), 20 cases of internal carotid artery aneurysms(ICAA), 2 cases of anterior pericallosal artery aneurysms and 8 cases of posterior circulation aneurysm. In endovascular group, the aneurysm had been embolised by either mechanical detachable coil(MDS) or guglielmi detachable coil(GDC) in 22 cases of posterior circulation aneurysm, and ICA has been occluded by detachable balloon in 25 cases of giant aneurysms. Results: In operative group, outcome was considered as good in 157 cases(90.8%), fair in 5 cases(2.9%), poor in 4 cases (2.3%) and dead in 9 cases(5.2%), without mortality in patients with Hunt and Hess Ⅰ Ⅱgrade. In endovascular group however, outcome was considered as good in 96 cases (91.4%), fair in 1 cases (1.0%), poor in 4 cases(3.8%) and dead in 4 cases(3.8%). Conclusions: Both microsurgical and endovascular therapy for intracranial aneurysms are attributed to minimal invasively neurosurgical and endovascular therapy for intracranial aneurysms belong to minimally invasive neurosurgery. For majority of intracranial aneurysms, the two above mentioned methods can be used alternatively and make the result safer and better.