脉络膜前动脉动脉瘤的外科治疗分析

Surgical treatment of patients with anterior choroidal artery aneurysm

目的探讨脉络膜前动脉动脉瘤的手术方法及其疗效。方法回顾性分析2015年1月至2021年5月外科治疗的88例脉络膜前动脉动脉瘤的临床资料,其中58例接受开颅夹闭术(夹闭组),30例接受血管内栓塞治疗(栓塞组)。出院时、出院6个月采用改良Rankin量表(mRS)评分评估预后,0~2分为预后良好,3~5分为预后不良。结果夹闭组术后复查CT未发现动脉瘤再出血,复查CTA或DSA均未见动脉瘤显影;术后发生颅内感染7例、肺部感染38例、脑积水5例、脉络膜前动脉供血区脑梗死11例;出院时预后良好51例(87.9%),预后不良7例;出院6个月,预后良好50例(86.2%),预后不良8例。栓塞组1例术后即刻DSA显示瘤颈少许残留,6个月复查DSA发现瘤颈压缩,采用支架辅助栓塞,其余动脉瘤均致密栓塞;术后发生肺部感染5例、脑积水1例、脉络膜前动脉供血区脑梗死1例;出院时预后良好26例(86.7%),预后不良4例;出院6个月,预后良好29例(96.7%),预后不良1例。出院后6个月CTA或DSA复查显示88例动脉瘤均无复发。结论对于脉络膜前动脉动脉瘤,开颅夹闭术和血管内栓塞治疗都是的有效方法,合理选择手术方案和预防并发症是改善病人预后的关键。

Objective To investigate the surgical methods and their efficacy for the patients with anterior choroidal artery aneurysm(ACAA).Methods A retrospective analysis was performed on the clinical data of 88 patients with ACAA,of whom 58 patients received surgical clipping(clipping group)and 30 patients received endovascular embolization(embolization group)from January 2015 to May 2021.The modified Rankin Scale(mRS)score was used to evaluate the prognosis on discharge and 6 months after discharge,with mRS score of 0~2 as good prognosis and score of 3~5 as poor prognosis.Results Of 58 patients in the clipping group,postoperative CT showed no aneurysm rebleeding;intracranial infection occurred in 7 patients,pulmonary infection in 38,hydrocephalus in 5 and cerebral infarction in the anterior choroidal artery territory in 11;postoperative CTA or DSA showed complete aneurysm clipping in all 58 patients of whom 51 patients(87.9%)had a good prognosis on discharge and 50 patients(86.2%)had a good prognosis 6 months after discharge.Of 30 patients in the embolization group,immediate postoperative DSA showed residual aneurysm neck in 1 patient who recieved stent-assisted embolization and dense packing in the other 29 aneurysms;pulmonary infection occurred in 5 patients,hydrocephalus in 1 and cerebral infarction in the anterior choroidal artery territory in 1;26 patients(86.7%)had a good prognosis on discharge and 29 patients(96.7%)had a good prognosis 6 months after discharge.CTA or DSA showed no aneurysm recurrence in all 88 patients 6 months after discharge.Conclusions Both clipping and endovascular embolization are effective methods for the treatment of patients with ACAA.Reasonable selection of surgical methods and prevention of complications are the keys to improving the prognosis of patients with ACAA.