手术治疗栓塞失败的颅内动脉瘤

Surgical treatment of intracranial aneuysms following failed embolization

目的 总结用开颅手术方法治疗栓塞失败的颅内动脉瘤的经验。方法 1999年 2月至 2 0 0 2年 4月采用手术方法治疗栓塞失败的颅内动脉瘤 8例 (男性 5例 ,女性 3例 ) ,其中后交通动脉瘤 3例 ,前交通动脉瘤 2例 ,大脑前动脉A1段动脉瘤 1例 ,大脑中动脉分叉部动脉瘤 1例 ,小脑后下动脉动脉瘤 1例。动脉瘤的直径平均为 12mm。结果 8例患者术后均恢复良好 ,脑血管造影复查 ,动脉瘤均完全消失 ,无动脉瘤残留。治疗期间均未发生动脉瘤再破裂出血 ,无手术合并症和术后死亡。结论 栓塞治疗颅内动脉瘤应严格掌握适应证。

Objective To introduce and summarize the experience of surgical treatment of intracranial aneurysms in which embolization was of failure.Methods 8 cases of intracranial aneurysms (5 male, 3 female) with failed embolization, including 3 cases of posterior communicating artery aneurysms, 2 cases of anterior communicating aneurysms, one case of A 1 segment, one case of middle cerebral artery bifurcation aneurysms, one case of posterior inferior cerebellar artery aneurysm, were treated by microsurgical procedures between February 1999 and April 2002. The mean diameter was 12 mm.Results All cases were clipped successfully and the post-operative procedures were smooth. Post-operative digital subtraction angiography (DSA) demonstrated that all aneurysms disappeared and there was no residual aneurysm. There was no aneurysm re-bleeding, no surgical complication and no mortality.Conclusion Choice of embolization must be according to strict adaptions. If residual aneurysms or re-vascularizion happen, surgical clipping is recommended.