Morphological characteristics associated with rupture risk of multiple intracranial aneurysms

Objective: To identify the morphological parameters that are related to intracranial aneurysms(IAs) rupture using a case-control model.Methods: A total of 107 patients with multiple IAs and aneurysmal subarachnoid hemorrhage between August 2011 and February 2017 were enrolled in this study.Characteristics of IAs location, shape, neck width, perpendicular height, depth, maximum size, flow angle, parent vessel diameter(PVD), aspect ratio(AR) and size ratio(SR) were evaluated using CT angiography.Multiple logistic regression analysis was used to identify the independent risk factors associated with IAs rupture.Receiver operating characteristic curve analysis was performed on the final model, and the optimal thresholds were obtained.Results: IAs located in the internal carotid artery(ICA) was associated with a negative risk of rupture, whereas AR, SR1(height/PVD) and SR2(depth/PVD) were associated with increased risk of rupture.When SR was calculated differently, the odds ratio values of these factors were also different.The receiver operating characteristic curve showed that AR, SR1 and SR2 had cut-off values of 1.01, 1.48 and 1.40, respectively.SR3(maximum size/PVD) was not associated with IAs rupture.Conclusions: IAs located in the ICA are associated with a negative risk of rupture, while high AR(>1.01), SR1(>1.48) or SR2(>1.40) are risk factors for multiple IAs rupture.

Superficial Temporal Artery to Middle Cerebral Artery Bypass and Endovascular Parent Artery Occlusion in the Treatment of Giant Intracranial Aneurysms

The authors are reporting on a study drawn from unpublished dissertation done by the corresponding author when he completed his neurosurgical training in Paris, France in 2004, few years before the advent of flow diverters. The study was a retrospective review of giant intracranial aneurysms treated by superficial temporal artery to middle cerebral artery bypass combined with endovascular occlusion of the parent artery. From 1990 to 2003, 29 consecutive cases of giant cerebral aneurysms, not suitable to selective treatment were managed in that way. Twenty-one medical records had enough data to allow objective evaluation. Sixteen female and five male patients bearing 21 giant aneurysms were involved. Their mean age was 46 years. The aneurysm was revealed by mass effect in 13 cases and subarachnoid hemorrhage in one case. On admission 19 patients presented with unruptured aneurysms and two have sustained a subarachnoid hemorrhage. The balloon occlusion test before the bypass operation was not tolerated in 18 patients. The treatment was completed in 19 patients and 17 of them had parent artery occlusion with latex detachable balloons. The only death of the series occurred before the endovascular treatment. The mean follow-up period was 30 months. After completion of the treatment, 16 (84%) patients had no symptom. Aneurysm recanalization or rupture was not observed after the parent artery occlusion. With the combination of superficial temporal artery to middle cerebral artery bypass + endovascular parent artery occlusion, 90% of giant intracranial aneurysms untreatable selectively were permanently excluded with a good outcome in 95%.

Three-dimensional CT angiography with volume rendering for the dignosis of multiple intracranial aneurysms

Objective: To evaluate the importance of 3D-CTA with volume rendering for the diagnosis of multiple intracranial aneurysms. Methods: Axial source images were obtained by helical CT scanning and reconstruction of 3D-CTA images was done by volume rendering technique in conjunction with multiplanar reformation. Results: In the past one year, there were 10 patients diagnosed as having multiple intracranial a-neurysms by 3D-CTA and altogether 24 aneurysms were visualized, including 10 small aneurysms (≤ 5mm. Three-dimensional CT angiography with volume rendering demonstrated aneurysms very well and provided useful information concerning the site, shape, size and spatial relationship with the surrounding vessels and bone anatomy. Conclusion: Three-dimensional CT angiography with volume rendering is a quick, reliable, and relatively noninvasive method for diagnosing multiple intracranial aneurysms. It delineates detailed aneurysmal morphology, and provides useful information for planning microsurgical approaches.

Wall shear stress in intracranial aneurysms and adjacent arteries

Hemodynamic parameters play an important role in aneurysm formation and growth. However, it is difficult to directly observe a rapidly growing de novo aneurysm in a patient. To investigate possible associations between hemodynamic parameters and the formation and growth of intracranial aneurysms, the present study constructed a computational model of a case with an internal carotid artery aneurysm and an anterior communicating artery aneurysm, based on the CT angiography findings of a patient. To simulate the formation of the anterior communicating artery aneurysm and the growth of the internal carotid artery aneurysm, we then constructed a model that virtually removed the anterior communicating artery aneurysm, and a further two models that also progressively decreased the size of the internal carotid artery aneurysm. Computational simulations of the fluid dynamics of the four models were performed under pulsatile flow conditions, and wall shear stress was compared among the different models. In the three aneurysm growth models, increasing size of the aneurysm was associated with an increased area of low wall shear stress, a significant decrease in wall shear stress at the dome of the aneurysm, and a significant change in the wall shear stress of the parent artery. The wall shear stress of the anterior communicating artery remained low, and was significantly lower than the wall shear stress at the bifurcation of the internal carotid artery or the bifurcation of the middle cerebral artery. After formation of the anterior communicating artery aneurysm, the wall shear stress at the dome of the internal carotid artery aneurysm increased significantly, and the wall shear stress in the upstream arteries also changed significantly. These findings indicate that low wall shear stress may be associated with the initiation and growth of aneurysms, and that aneurysm formation and growth may influence hemodynamic parameters in the local and adjacent arteries.

CEREBRAL ARTERY RECONSTRUCTION IN THE TREATMENT OF LARGE AND GIANT INTRACRANIAL ANEURYSMS

From 1978 to 1988, 14 giant intracranial aneurysms(more than 2.4 cm in diameter) and one large aneurysm (1.5cm in diameter) were treated by extracranial/intracranial(EC/IC) bypass or cerebral artery reconstruction. Of theaneurysms, 10 were located at the intracavernous carotid ar-tery (CCA). One of the 10 anourysms was posttraumatic andlocated at both the carotid-ophthalmic artery segment and thebifurcation of the internal carotid artery (ICA). Three wereseen at the middle cerebral artery (MCA) trunk.Theaneurysms were demonstrated by angiography and CTscanning. They were treated with trapping of the aneurysm andsuperficial temporal artery (STA)/middle cerebral artery(STA-MCA) bypass with/without a graft (6 cases), cervicalICA ligation and STA-MCA bypass with / without a graft (6)aneurysm excision with an end-to-end anastomosis of theMCA and a STA-MCA bypass with a graft (1), proximal

Risk factors and outcomes of postoperative stroke in surgical treatment for giant intracranial aneurysms

Background:Giant intracranial aneurysms(GIAs)are challenges for surgical treatment.Risk factors of postoperative stroke remain unclear.This study aims to investigate the predictors of postoperative stroke in GIAs and the impact of stroke on outcomes.Methods:We performed a retrospective medical record review of patients with GIAs who received microsurgery at our institution between 2011 and 2018.Multivariate logistic regression analyses were carried out to identify risk factors for postoperative stroke.The clinical and angiographic outcomes were compared between patients with and without stroke.Results:A total of 97 patients were included in this study.Surgical modalities included direct aneurysm neck clipping in 85 patients(87.7%),trapping with the bypass in 8(8.2%),proximal artery ligation in 1(1%),and bypass alone in 3(3.1%).Postoperative stroke was found in 26 patients(26.8%).Independent factors that affect postoperative stroke were recurrent aneurysm(OR,10.982;95%CI,1.976-61.045;P=0.006)and size≥3.5 cm(OR,3.420;95%CI,1.133-10.327;P=0.029).Combined perioperative mortality and morbidity was 26.8%.Follow-up was achieved from 89 patients(91.8%),with a mean follow-up period of 39 months(range 19 to 94 months).Good outcomes were observed in 75 patients(84.3%)and poor outcomes were observed in 14 patients(15.7%).Conclusions:Postoperative stroke was significantly associated with clinical outcome.Favorable outcomes can be achieved in most patients with GIAs after appropriate microsurgical modality.Recurrent aneurysm and size≥3.5 cm are risk factors of postoperative stroke.

Fatal Outcome after Delayed Pipeline Embolization Device Migration for the Treatment of a Giant Superior Cerebellar Artery Aneurysm: Technical Note for Complication Avoidance

Purpose: Flow diversion is a relatively novel technique to treat some intracranial aneurysms. With new techniques, unusual complications can occur. We described a case of Pipeline Embolization Device (PED) migration, strategy for its recognition, and a technical point to prevent its occurrence. Publication of these rare events is important to make physicians aware of potential complications. Methods: A patient with a previously coiled giant superior cerebellar aneurysm presented with brainstem compression symptoms. Imaging verified progressive aneurysm growth. A decision was made to treat the aneurysm with PED. Results: Development of new neurologic symptoms prompted a computed tomography that showed hydrocephalus. An angiogram also showed recanalization of the aneurysm secondary to upward migration/retraction of the flow diverter. A ventriculo-peritoneal shunt was implemented and planning for placement of a second flow diverter was made. Unfortunately, the patient expired while waiting for the endovacular intervention. Conclusions: PED migration may occur even after correct placement of the device. Early recognition of this complication is essential. When clinical changes occur, it is paramount that this uncommon, but potentially deadly, complication is suspected. Appropriate sizing and deployment technique are important for the long-term stability of the device.

Giant cavernous aneurysms occluded by aneurysmal thrombosis,calcification,parent artery occlusion:A case report and review of literature

BACKGROUND Patients with giant intracranial aneurysms(GIAs)are at a high risk of rupture,morbidity,and mortality even after surgical or endovascular treatment.We described a case of a spontaneously occluded GIA secondary to gradual growth of the GIA,continuously progressed aneurysmal thrombosis,complete aneurysmal calcification and complete occlusion of the parent artery-the right internal carotid artery(RICA).CASE SUMMARY A 72-year-old female patient complained of sudden pain in her right eye upon admission to our hospital.She had been diagnosed with a GIA[30 mm(axial)×38 mm(coronal)×28 mm(sagittal)]containing an aneurysmal thrombus located in the cavernous sinus segment of RICA diagnosed by magnetic resonance imaging(MRI),enhanced MRI,and magnetic resonance angiography more than 14 years ago.Later,with slow growth of the cavernous carotid GIA,aneurysmal thrombosis progressed continuously,spontaneous occlusion of the RICA,complete aneurysmal calcification,and occlusion of the GIA occurred gradually.She had no history of subarachnoid hemorrhage but missed the chance for endovascular therapy at an early stage.As a result,she was left with severe permanent sequelae from the injuries to the right cranial nerves Ⅱ,Ⅲ,Ⅳ,V1/V2,and Ⅴ.CONCLUSION The risk of rupture of the cavernous carotid GIAs was relatively low and possibly further be reduced by the stasis flow and spontaneous occlusion of the parent artery internal carotid artery(ICA)induced by the mass effect of the cavernous carotid GIAs and the extremely rare aneurysmal calcification.However,nowadays,it is advisable to recommend early endovascular treatment for the cavernous carotid GIAs to prevent injuries to the surrounding intracranial nerves and occlusion of the ICA,mainly caused by the mass effect of the cavernous carotid GIAs.

Subarachnoid hemorrhage due to systemic lupus erythematosus associated with multiple intracranial artery aneurysms

To the Editor:Systemic lupus erythematosus (SLE)is an autoimmune-mediated systemic inflammatory disease which involves nearly all organs of the body,and it is associated with premature atherosclerosis,vasculitis,and coagulopathy,^[1]Cases of subarachnoid hemorrhage (SAH)due to cerebral aneurysm associated with SLE are being reported more frequently.However,SAH due to SLE associated with multiple cerebral artery aneurysms that rapidly develop within only 2 months is rare,and the causal relations between cerebral aneurysm and SLE are not clearly understood.Herein,we reported a case of multiple cerebral artery aneurysms due to SLE,with enough evidence to confirm that the cerebral artery aneurysms were solely due to SLE.

颅内多发动脉瘤破裂的临床与影像学危险因素分析

目的:探讨颅内多发动脉瘤破裂的临床与影像学中的潜在危险因素。方法:回顾性分析2013年4月至2021年12月在本院收治的颅内多发动脉瘤患者的临床和影像数据,根据动脉瘤是否破裂分为破裂组与未破裂组,对两组临床和影像学参数进行单因素分析筛选出具有统计学意义的危险因素,并将其作为自变量,进一步进行多因素Logistic回归分析。探讨影响颅内多发动脉瘤破裂的危险因素。结果:单因素回归分析结果表明破裂组(n=52)与未破裂组(n=85)两组患者的年龄、性别、高血压、高脂血症、血管硬化性疾病、动脉瘤最长径、宽度、长宽比及动脉瘤部位均具有统计学差异(均P<0.05);年龄越小,越容易破裂(P<0.05);破裂组的最长径、宽度、长宽比值均显著高于未破裂组(P<0.05);前交通动脉、后交通动脉、大脑中动脉、基底动脉破裂率高于其他部位动脉瘤(P<0.05)。多因素Logistic回归分析结果表明颅内多发动脉瘤破裂的独立危险因素为性别(OR=3.664,95%CI:1.577~8.515,P=0.003)、动脉瘤最长径(OR=1.405,95%CI:1.130~1.747,P=0.002)及动脉瘤位置,而前交通动脉(OR=26.747,95%CI:5.384~132.883,P<0.001)和后交通动脉(OR=15.288,95%CI:3.659~63.885,P<0.001)破裂风险最高;高脂血症是颅内多发动脉瘤破裂的独立保护因素(OR=0.103,95%CI:0.026~0.405,P=0.001)。结论:性别、动脉瘤最长径及动脉瘤位置是颅内多发动脉瘤破裂的独立危险因素,而高脂血症是颅内多发动脉瘤破裂的独立保护因素,这为将来针对颅内多发动脉瘤中未破裂动脉瘤制定个性化的预防策略提供了重要依据。

3D-Slicer技术助诊常规MRI未确诊的颅内巨大动脉瘤临床案例分析

颅内巨大动脉瘤(GIAs)是目前手术最难处理的脑血管病变之一。尽管显微外科技术取得了显著的进步,但相应的手术发病率和死亡率仍然高达20%。3D-Slicer是一种用于医学图像可视化和分析的软件,本文报道由3D-Slicer技术助诊常规MRI未能确诊的GIAs 1例,指导临床对于颅内动脉瘤尤其是巨大血栓性动脉瘤的夹闭和切除,具有非常好的应用发展前景。

多辅助手段在脉络膜前动脉动脉瘤显微外科夹闭术的应用

目的探讨多辅助手段在脉络膜前动脉(anterior choroidal artery,AChA)动脉瘤显微外科夹闭术的应用,以期提高AChA动脉瘤夹闭成功率,减少动脉瘤瘤颈残留及缺血性脑卒中发生率。方法回顾性分析收治18例AChA动脉瘤患者病例资料,术前存在蛛网膜下腔出血(subarachnoid hemorrhage,SAH)14例,均采用开颅显微外科手术夹闭(占同期手术夹闭动脉瘤约4.4%)。术前所有AChA动脉瘤患者行CTA、3D-DSA检查,全面了解动脉瘤大小、形态、朝向、瘤颈宽度,与载瘤动脉、周围分支血管的关系及与骨性结构(前床突)的关系,指导术中头位摆放,放置瘤夹角度,并结合术中电生理监测体感诱发电位(somatosensory evoked potentials,SEP)和运动诱发电位(motor-evoked potentials,MEP),经颅多普勒超声(transcranial Doppler,TCD)监测载瘤动脉及其分支血流通畅情况,吲哚菁绿(indocyanine green,ICG)血管荧光造影了解动脉瘤是否显影及血管充盈灌注情况。在完全夹闭动脉瘤颈基础上,分析术后出现动脉瘤残留及缺血性卒中发生情况。结果17例AChA动脉瘤成功精准夹闭,仅1例出现瘤颈残留情况,2例出现脑梗死。随访10~20个月,无动脉瘤再出血与复发情况。改良RANKIN量表(modified Rankin scale,mRS)评分:0分5例,1分7例,2分4例,3分1例,4分1例,无死亡病例。结论术前熟练应用CTA及3D-DSA重建技术充分了解AChA动脉瘤三维结构及具体形态,准确判断夹闭动脉瘤难易度,依据术中电生理监测、TCD及ICG血管荧光造影技术明确动脉瘤夹闭后是否存在残留、载瘤动脉通畅性或穿支动脉被夹闭情况,不断调整动脉瘤夹实现最佳夹闭效果,可减少动脉瘤瘤颈残留及缺血性脑卒中发生率。

3D Slicer三维重建辅助诊治大脑前动脉多发假性动脉瘤1例

颅内创伤性假性动脉瘤(TIPA)常见于锐器穿刺损伤、交通事故等,大多数发生在颈内动脉床突段以及大脑前动脉远端分支,如胼周、胼缘动脉。本病临床少见,起病隐匿,一旦破裂出血,则后果严重。目前,此病的发病机制、诊断、处理方法尚无统一意见。本文报道1例颅眶异物穿通伤合并大脑前动脉(A3段)多发假性动脉瘤。根据颅脑CTA数据,应用3D Slicer软件进行三维重建,发现大脑前动脉分叉血管形态异常,考虑多发动脉瘤,左侧后交通动脉囊状动脉瘤,结合颅骨重建及颅内创伤血肿通道情况分析,与此次颅眶创伤通道高度重合。3D-DSA明确诊断后,采用支架辅助栓塞术治疗大脑前动脉多发假性动脉瘤,左侧后交通动脉瘤2个月后分期处理,术后恢复良好。这提示3D Slicer三维重建技术可提高CTA诊断颅内动脉瘤的敏感性和特异性,甚至接近金标准DSA;还可重建颅骨、血肿和周围骨组织,模拟手术,用于术前指导。

颅内多发动脉瘤外科治疗的临床研究

目的研究颅内多发动脉瘤外科治疗的临床特点。方法回顾分析63例颅内多发动脉瘤病人的临床资料，将出院时的GOS评分作为预后良好（4—5级），差（1—3级），分别评价了年龄、性别、治疗手段、术前Hunt—Hess分级、Fisher分级、动脉瘤部位、侧别、大小、数量等因素的影响。结果GOS评分预后良好49例，差14例。单因素分析显示术前Hunt—Hess分级和Fisher分级与预后相关（P〈0．05）。多因素的Logistic回归分析结果显示各因素与预后均无明显相关（P〉0．05）。结论术前Hunt—Hess分级和Fisher分级会影响颅内多发动脉瘤病人的疗效，治疗方案的选择会提高其疗效。手术和介入的治疗效果未见明显差异。

颅内多发动脉瘤的诊断与治疗策略

目的探讨颅内多发动脉瘤的影像学特点、诊断与治疗策略。方法回顾性分析96例共234枚颅内动脉瘤的临床及影像学特点,结合头颅CT提示的蛛网膜下腔出血模式及DSA结果判定责任动脉瘤。对责任动脉瘤均采取显微夹闭术或者血管内介入栓塞术积极治疗,对于非责任动脉瘤予以选择性治疗。结果 96例多发动脉瘤行栓塞治疗56例,夹闭治疗28例,未治疗12例。44例一期治疗所有动脉瘤,4例分期处理所有动脉瘤,36例仅治疗责任动脉瘤。接受治疗的84例患者,出院时预后格拉斯哥预后评分(GOS)评分5分62例,4分12例,3分8例,1分2例。术后6个月DSA随访30例,1例复发接受再治疗,余29例治疗效果稳定。结论颅内多发动脉瘤应在诊断全面的基础上,正确判断责任动脉瘤并积极治疗,对于非责任病灶需要综合评估出血风险,采取个体化治疗措施,尽量一期治疗所有动脉瘤,减少再出血风险。

单纯血流导向装置或联合弹簧圈治疗前循环大型及巨大型颅内动脉瘤的随访观察

目的 评估Tubridge血流导向装置（FD）治疗颅内前循环大型或巨大型动脉瘤的安全性及有效性.方法 回顾性收集与分析2010年8月-2012年8月应用Tubridge FD治疗的28例（共28个）颈内动脉囊状宽颈未破裂动脉瘤患者的临床资料及随访结果.结果 ①28个动脉瘤大小为11.3~44.0 mm,平均（21.6±7.1） mm.共置入Tubridge 支架 33枚,除1枚支架未能完全打开外,其余均成功置入目标位置.②28个动脉瘤中18个动脉瘤内填塞了弹簧圈,即刻栓塞结果按Raymond分级,瘤颈残留2例,大部栓塞16例;10个动脉瘤采取单纯FD治疗,置入FD后造影显示所有动脉瘤的对比剂充盈方式改变,瘤内对比剂滞留明显,其中7例术后瘤体充盈体积明显减少（5例充盈率减少为0~50%,2例充盈率减少≥50%）.治疗过程中,无一例发生操作相关出血性或缺血性事件.③临床随访过程中（6~30个月,平均19个月）,5例患者出现了短暂性的症状加重,13例患者症状缓解,6例改善,4例稳定.④术后25个动脉瘤获得DSA随访（5~24个月,平均9.9个月）,其中18例动脉瘤影像学治愈（72%）,6例改善（24%,仅为少量瘤颈残留）,1例稳定（4%）;支架覆盖的分支动脉均保持通畅,未发生支架内狭窄及载瘤动脉闭塞.结论 Tubridge FD治疗颅内前循环大型或巨大型动脉瘤是安全和有效的.但本组资料仅为单中心随访结果,长期疗效仍有待于前瞻性多中心的对照研究证实.

颅内巨大动脉瘤的手术治疗

目的探讨颅内巨大动脉瘤的手术时机、手术方法及疗效。方法回顾性分析2001年1月～2010年1月南方医院神经外科治疗的15例颅内巨大动脉瘤。动脉瘤夹夹闭8例;动脉瘤孤立并颅内-颅外血管架桥术1例;大隐静脉移植颅内-颅外血管架桥并载瘤动脉闭塞3例;瘤体切除,瘤壁缝合1例;单纯孤立2例。结果死亡2例(13%)。其余13例经半年的随访,好12例(80%),差1例(7%)。结论巨大动脉瘤手术设计应个体化,术者应是具备血管重建能力的有经验的显微神经外科医师。

颅内巨大动脉瘤诊断及治疗

目的颅内巨大动脉瘤占颅内动脉瘤的5％－7％，有人报告可达到20％以上。由于部位深，周围结构复杂，以及瘤颈难以处理等因素，治疗较困难。本文报告巨大动脉瘤36例，占我院同期收治的动脉瘤6.6％（36／547）。方法血管内栓塞21例，手术夹闭或切除7例，载瘤动脉栓塞3例，保守治疗5例。结果血管内栓塞21例，其中完全栓塞3例，栓塞80％以上者（含完全栓塞）15例，余6例不足80％，死亡2例。手术夹闭或切除者7例，重残及死亡各1例。保守治疗组1例造影后破裂死亡.结论21例血管内治疗，尽管大多数病例（71．4％）仅栓塞80％，但近期效果较好。对深部位及危重的巨大动脉瘤病人，可考虑采用血管内治疗方法，但考虑血管内治疗历史短，危险性及尚未完全验证的功效，必须长期随访。

多发性颅内动脉瘤的显微手术治疗

目的探讨多发性颅内动脉瘤的诊断、手术时机和显微手术方法。方法回顾性分析武汉大学人民医院2003年3月至2007年10月期间40例确诊为多发性颅内动脉瘤患者的临床资料。结果36例行显微手术夹闭治疗,其中治愈或良好26例,轻残5例,重残2例,死亡3例;1例行血管内栓塞治疗;2例保守治疗;1例放弃治疗。结论CT、MRA、CTA可为多发性颅内动脉瘤的诊断提供重要的信息,DSA仍然是诊断多发性颅内动脉瘤的金标准。显微手术夹闭是多发性颅内动脉瘤的一种成熟、可靠和有效的治疗方法。

颅内多发动脉瘤的3D-CTA诊断及手术治疗

目的探讨颅内多发动脉瘤的3D-CTA诊断价值和开颅动脉瘤颈夹闭和(或)血管内栓塞治疗效果。方法回顾性分析39例经3D-CTA确诊的颅内多发动脉瘤临床资料,36例采用开颅动脉瘤颈夹闭和/或血管内栓塞治疗,一期单侧翼点入路开颅动脉瘤颈夹闭术18例,双侧翼点或翼点+前纵裂入路动脉瘤颈夹闭术6例;二期开颅动脉瘤颈夹闭术3例;开颅动脉瘤颈夹闭术+血管内栓塞术4例;单纯血管内栓塞术5例。手术夹闭动脉瘤颈64个,血管内栓塞14个,11个动脉瘤未予处理。结果39例共发现动脉瘤89个,其中2个动脉瘤30例,3个动脉瘤7例,4个动脉瘤2例;31例术后复查3D-CTA,其中30例显示动脉瘤夹闭良好或完全栓塞,1例动脉瘤颈夹闭不全术后一个月动脉瘤再次破裂出血,再次开颅手术夹闭,痊愈出院,随访3个月至7年,按GOS预后分级,良好29例,轻残5例,重残2例,死亡3例均因动脉瘤再次破裂未处理。结论3D-CTA可靠、快捷、安全,可作为颅内多发动脉瘤的首选诊断方法,开颅动脉瘤颈夹闭和/或血管内栓塞治疗效果良好。