夹闭术治疗栓塞后复发的颅内动脉瘤的疗效分析

Microsurgical management of recurrent intracranial aneurysms after embolization

目的探讨栓塞后复发的颅内动脉瘤的手术治疗方法及其疗效。方法回顾性分析夹闭术治疗的10例栓塞后复发的颅内动脉瘤的临床资料,其中后交通动脉动脉瘤4个,前交通动脉动脉瘤3个,大脑中动脉动脉瘤2,基底动脉顶端动脉瘤1个。结果 10例动脉瘤夹闭完全,其中5个动脉瘤内弹簧圈术中全部或部分去除,5个动脉瘤内弹簧圈予以保留。术后CTA或DSA显示动脉瘤夹闭完全,载瘤动脉通畅。10例出院时GOS评分5分8例,4分1例,3分1例。术后平均随访20个月,GOS评分5分9例,4分1例(术后发生脑血管痉挛造成脑梗死);随访期间无动脉瘤复发。结论栓塞后复发的颅内动脉瘤具有较高的手术难度,夹闭术仍然是一种安全有效的治疗方法。

Objective To explore the principles and techniques of microsurgical treatment of recurrent intracranial aneurysms after the endovascular embolization.Methods The clinical data of10patients with recurrent intracranial aneurysms after the endovascular embolization,of whom,4had posterior communicating artery aneurysms,3anterior communicating artery aneurysms,2middle cerebral artery aneurysms and1basilar artery tip aneurysm,were analyzed retrospectively,including the treatment methods,clinical curative effects and so on.All the patients underwent microsurgical clipping of the aneurysms.Results All the aneurysms were completely occluded in10patients.The coils used for the embolization were reserved in5patients and not in the other5.The following-up for20months showed that of10patients,9recovered well and1not according to GOS.CTA or DSA showed that all the aneurysms were completely occluded and the aneurysms did not recurred in all the patients.Conclusions The microsurgery for the recurrent intracranial aneurysms after the embolization is difficult,but it is a safe and effective method to treat them.