颅内动脉瘤手术与介入治疗效果比较

INTRACRANIAL ANEURYSMS: OPERATION VERSUS INTERVENTIONAL THERAPY

①目的 比较手术与介入治疗颅内动脉瘤的效果。②方法 对 16 5例 (181个 )动脉瘤分别采用手术与介入治疗的效果进行分析。手术治疗 12 3例 (手术组 ) 132个动脉瘤 ,其中多发性动脉瘤 9例。介入治疗 4 2例(栓塞组 ) 4 9个动脉瘤 ,其中多发性动脉瘤 7例。③结果 手术组瘤颈夹闭动脉瘤 12 6个 ,其中夹闭加切除 16个 ;动脉瘤加固 6个 ;治愈 110例 (89.4 % ) ,有后遗症者 8例 (6 .5 % ) ,死亡 5例 (4 .0 % )。栓塞组动脉瘤完全闭塞 38个(77.6 % ) ,栓塞 90 %以上的 6个 (12 .2 % ) ,栓塞 70 %～ 90 %的 3个 ,2例多发性病人各栓塞了 1个 ,其中 1个栓塞不成功而行手术治疗 ;治愈 37例 (88.1% ) ,有后遗症者 2例 (4 .7% ) ,死亡 3例 (7.1% )。④结论 显微技术瘤颈夹闭术效果肯定 ,被公认为是目前最好的治疗方法之一。血管内介入治疗达到了近似开颅手术的治疗效果。尤其是手术处理困难的宽颈动脉瘤、巨大动脉瘤及多发性动脉瘤等 ,栓塞治疗效果满意。破裂动脉瘤均应急症手术或栓塞治疗。

Objective To compare the outcome of operation with interventional therapy for intracranial aneurysms. Methods\ 165 cases with 181 aneurysms treated with operation or interventional therapy were analyzed. In which, 123 cases( 132 aneurysms, 9 multiple ones included) were treated operatively. 42 cases( 49 aneurysms, 7 multiple ones included) treated interventionally.\ Results\ In operative group, the necks of aneurysms were clipped in 126 , aneurysms removed in 16, and wrapped 6. 110 cases (89.4%) were cured, 8 (6.5%) with neurological sequelae, 5 cases ( 4.0% ) died. In interventional group, 38 aneurysms (77.6%) were totally embolized, 6 (12.2%) embolized over 90%, while 3 between 70%-90%. For multiple ones, one was embolized , another one was converted to operation due to failure of embolization. 37 cases (88.1%) were cured, 2 ( 4.7% ) with sequelae, 3 (7.1%) died.\ Conclusion\ Micro surgical technique for clipping the neck of an aneurysm is considered to be one of the best treatments. The interventional therapy can achieve similar results as done by operation, especially for cases difficult to be treated by surgery such as aneurysms with wide neck, giant or multiple ones. Ruptured aneurysm must be treated urgently with surgery or interventional therapy.