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CEREBRAL ARTERY RECONSTRUCTION IN THE TREATMENT OF LARGE AND GIANT INTRACRANIAL ANEURYSMS
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作者 周良辅 蒋大介 《Chinese Medical Journal》 SCIE CAS CSCD 1994年第1期42-47,共6页
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... 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 展开更多
关键词 MCA CEREBRAL ARTERY RECONSTRUCTION IN THE TREATMENT OF large and giant intracranial aneurysms STA
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Superficial Temporal Artery to Middle Cerebral Artery Bypass and Endovascular Parent Artery Occlusion in the Treatment of Giant Intracranial Aneurysms 被引量:1
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作者 Aurélien Ndoumbe Aimée Redondo 《Open Journal of Modern Neurosurgery》 2018年第2期147-161,共15页
The authors are reporting on a study drawn from unpublished dissertation done by the corresponding author when he completed his neurosurgical training in Paris, France in 2004, few years before the advent of flow dive... The authors are reporting on a study drawn from unpublished dissertation done by the corresponding author when he completed his neurosurgical training in Paris, France in 2004, few years before the advent of flow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%. 展开更多
关键词 giant Cerebral/intracranial Aneurysm Superficial Temporal ARTERY to Middle CEREBRAL ARTERY BYPASS Balloon Test OCCLUSION Parent ARTERY OCCLUSION Flow-Diversion
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Risk factors and outcomes of postoperative stroke in surgical treatment for giant intracranial aneurysms
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作者 Hao Wang Junlin Lu +1 位作者 Xin Chen Qiang Hao 《Chinese Neurosurgical Journal》 CAS CSCD 2023年第2期105-113,共9页
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 ... 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. 展开更多
关键词 giant intracranial aneurysms MICROSURGERY OUTCOME STROKE COMPLICATION
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Giant cavernous aneurysms occluded by aneurysmal thrombosis,calcification,parent artery occlusion:A case report and review of literature
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作者 Ming-Xi Wang Qing-Bin Nie 《World Journal of Clinical Cases》 SCIE 2024年第16期2822-2830,共9页
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 second... 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. 展开更多
关键词 giant intracranial aneurysm Cavernous sinus Aneurysmal thrombosis and calcification Spontaneous occlusion of the parent artery Conservative therapy Case report
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Surgical management of large and giant intracavernous and paraclinoid aneurysms 被引量:5
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作者 XU Bai-nan SUN Zheng-hui JIANG Jin-li WU Chen ZHOU Ding-biao YU Xin-guang LI Bao-min 《Chinese Medical Journal》 SCIE CAS CSCD 2008年第12期1061-1064,共4页
Background Due to their location, large and giant intracavernous and paraclinoid aneurysms remain a challenge for vascular neurosurgeons, We identified characteristics, surgical indications and treatment strategies of... Background Due to their location, large and giant intracavernous and paraclinoid aneurysms remain a challenge for vascular neurosurgeons, We identified characteristics, surgical indications and treatment strategies of large and giant intracavernous and paraclinoid aneurysms in 36 patients.Methods The pterional approach was routinely used. The cervical internal carotid artery was exposed for proximal control of parent vessel and retrograde suction decompression. Paraclinoid aneurysms were directly clipped, intracavernous pseudoaneurysm was repaired and the intracavernous aneurysms were trapped with extracranial-intracranial bypass of saphenous vein graft. Intraoperative electroencephalogram (EEG) and somatosensory evoked potential (SSEP) monitoring were used to detect cerebral ischemia during the temporary occlusion of parent arteries. Microvascular Doppler ultrasonography was used to assess blood flow of the parent and branch vessels. Endoscopy was helpful particularly in dealing with internal carotid artery posterior wall aneurysms. Postoperative digital subtraction angiography (DSA) was performed in 33 of the 36 patients.Results Thirty-two paraclinoid aneurysms were directly clipped, 1 intracavernous pseudoaneurysm was repaired and the other 3 intracavernous aneurysms were trapped with revascularization. Except for two patients who died in the early postoperative stage, 34 patients' follow-up was 6-65 months (mean 10 months) and a Glasgow Outcome Scale score of 4 to 5 at discharge. At the 6-month follow-up examination, Rankin Outcome Scale scores were 0 to 2 in 32 patients. EEG and SSEP monitoring changed in six patients. Twelve clips were readjusted when insufficient blood flow in parent and branch vessels was detected. Three posterior wall aneurysms were clipped.Conclusions Intracavernous aneurysms not amenable to endovascular treatment should be treated surgically and surgical treatment is the first option for paraclinoid aneurysms. The temporary parent vessel occlusion, retrograde suction decompression, endoaneurysmectomy, parent vessel reconstruction, vascular anastomosis, electrophysiological monitoring, Doppler ultrasonography and endoscopy are essential techniques in the treatment of the large and giant intracavernous and paraclinoid aneurysms. 展开更多
关键词 large and giant aneurysm intracavernous PARACLINOID BYPASS surgical management CLIP
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Application of hybrid operating rooms for clipping large or giant intracranial carotid-ophthalmic aneurysms
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作者 Nai Zhang Wen-Qiang Xin 《World Journal of Clinical Cases》 SCIE 2020年第21期5149-5158,共10页
BACKGROUND A hybrid operating room(Hybrid-OR)is a surgical theatre that combines a conventional operating room with advanced medical imaging devices.There are still plenty of limitations when endovascular treatment or... BACKGROUND A hybrid operating room(Hybrid-OR)is a surgical theatre that combines a conventional operating room with advanced medical imaging devices.There are still plenty of limitations when endovascular treatment or microsurgical treatment is used individually to treat large or giant carotid-ophthalmic aneurysms.AIM To explore and summarize the technical features and effectiveness of the application of a Hybrid-OR in managing major intracranial carotid-ophthalmic aneurysms.METHODS The Department of Neurosurgery treated 12 cases of large or giant intracranial carotid-ophthalmic aneurysms between March 2013 and December 2019 in a Hybrid-OR.All cases were treated with clipping and parent vessel reconstruction.RESULTS With the assistance of the Hybrid-OR,the rate of incomplete intraoperative aneurysm clipping decreased from 25%(3/12)to 0%,while the rate of vessel stenosis decreased from 16.7%(2/12)to 8.35%(1/12).In terms of thromboembolic events,ischemic infarction complication occurred in only one patient,and none of the patients experienced embolic infarction complications.All 12 patients were followed for an average of 3 years,and no aneurysms recurred.The postoperative recovery was evaluated with the modified Rankin Scale(mRS):11 patients showed no symptoms(mRS=0),1 patient showed slight disability(mRS 1-2),and none of the patients had severe disability(mRS=5)or died(mRS=6).CONCLUSION The Hybrid-OR provides new ideas for the surgical clipping of large or giant intracranial carotid-ophthalmic aneurysms and decreases the rate of intraoperative vessel stenosis and unsuccessful clipping. 展开更多
关键词 Balloon Microsurgical clipping Hybrid operating room large or giant carotid-ophthalmic aneurysm
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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
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作者 李天宇 高俊逸 +3 位作者 秦瑞琦 丁少华 张继 吴梅 《CT理论与应用研究(中英文)》 2024年第4期519-523,共5页
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... 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。 展开更多
关键词 磁共振成像 颅内巨大动脉瘤 3D-Slicer软件 动脉瘤切除术
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血流导向装置在颅内椎基底动脉干大动脉瘤治疗中的应用
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作者 王均 夏坤伟 徐伟 《中国实用神经疾病杂志》 2024年第10期1259-1264,共6页
目的探讨血流导向装置在颅内椎基底动脉干大动脉瘤(VBTLAs)治疗中的应用价值。方法回顾宜宾市第二人民医院2018-01—2023-08治疗的45例颅内VBTLAs患者的临床资料,其中采用血流导向装置治疗者20例(A组),采用支架辅助弹簧圈栓塞治疗者25... 目的探讨血流导向装置在颅内椎基底动脉干大动脉瘤(VBTLAs)治疗中的应用价值。方法回顾宜宾市第二人民医院2018-01—2023-08治疗的45例颅内VBTLAs患者的临床资料,其中采用血流导向装置治疗者20例(A组),采用支架辅助弹簧圈栓塞治疗者25例(B组),对比2组治疗效果、预后、术后复查结果及颅脑血流动力学等。结果2组患者术后支架置入成功率均为100%,A组、B组术后即刻动脉瘤完全栓塞率(90.00%比80.00%)比较无统计学差异(P>0.05)。A组手术时间短于B组(P<0.05),但2组住院时间比较无统计学差异(P>0.05)。A、B组围术期及随访期间并发症发生情况及出院时、术后6个月的预后结局比较无统计学差异(P>0.05)。A组、B组术后6个月时分支血管通畅率(85.00%比92.00%)比较无统计学差异(P>0.05)。A组术后2d时瘤腔内平均壁面应切力(WSS)、瘤颈与载瘤动脉的血流速度低于B组,低壁面剪应力区域(LSA)、瘤腔内的相对滞留时间(RRT)及患侧大脑中动脉的血流速度高于B组(P<0.05)。结论血流导向装置对颅内VBTLAs患者的动脉瘤栓塞率、预后结局与支架辅助弹簧圈栓塞一致,但可改善患者血流动力学。 展开更多
关键词 颅内椎基底动脉干大动脉瘤 血流导向装置 支架辅助弹簧圈栓塞 动脉瘤栓塞率 预后 脑血流动力学
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Fatal Outcome after Delayed Pipeline Embolization Device Migration for the Treatment of a Giant Superior Cerebellar Artery Aneurysm: Technical Note for Complication Avoidance
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作者 Ramón Navarro Edison J. Cano +2 位作者 Leonardo B. C. Brasiliense Guilherme Dabus Ricardo A. Hanel 《Open Journal of Modern Neurosurgery》 2014年第4期163-168,共6页
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, ... 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. 展开更多
关键词 giant intracranial ANEURYSM ENDOVASCULAR TREATMENT Flow Diverter COMPLICATION MIGRATION
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LVIS支架辅助栓塞颅内大型动脉瘤的疗效 被引量:2
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作者 李孟凯 张义森 +4 位作者 王坤 张莹 李文强 田忠彬 刘健 《中国临床神经外科杂志》 2023年第8期500-503,532,共5页
目的探讨LVIS支架辅助弹簧圈栓塞颅内大型动脉瘤的有效性和安全性。方法回顾性分析2014年10月至2017年5月采用LVIS支架辅助栓塞治疗的24例颅内大型动脉瘤的临床资料。结果24例均为单发动脉瘤,动脉瘤最大径10.1~20.2mm,平均为13.7 mm。2... 目的探讨LVIS支架辅助弹簧圈栓塞颅内大型动脉瘤的有效性和安全性。方法回顾性分析2014年10月至2017年5月采用LVIS支架辅助栓塞治疗的24例颅内大型动脉瘤的临床资料。结果24例均为单发动脉瘤,动脉瘤最大径10.1~20.2mm,平均为13.7 mm。24个动脉瘤均使用一枚LVIS支架,所有支架都成功打开并顺利完成动脉瘤填塞;术后即刻造影显示Raymond分级Ⅰ级14例,Ⅱ级9例,Ⅲ级1例。3例围手术期出现并发症,包括1例颈内动脉交通段破裂动脉瘤发生术中破裂,1例左侧颈内动脉眼动脉段动脉瘤术后1 h发生支架内血栓形成,1例右侧颈内动脉眼动脉段动脉瘤栓塞术后出现同侧视力障碍。21例(87.5%)进行3.9~36.8个月的临床随访,平均(10.85±8.6)个月,20例mRS评分0分,1例mRS评分1分。18例(75.0%)获得平均9.94个月血管影像学随访,5例动脉瘤出现复发,11例动脉瘤无明显变化,2例动脉瘤进一步愈合。结论LVIS支架辅助栓塞是治疗颅内大型动脉瘤的安全的、可行的方法。 展开更多
关键词 颅内大型动脉瘤 LVIS支架 血管内治疗 疗效
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颈内动脉-后交通动脉瘤伴动眼神经麻痹大弹簧圈技术栓塞治疗的效果及安全性 被引量:1
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作者 郝敏丽 丁奇 张慧娟 《中国实用神经疾病杂志》 2023年第1期46-50,共5页
目的分析颈内动脉-后交通动脉瘤伴动眼神经麻痹患者采用大弹簧圈技术栓塞治疗的效果及安全性。方法纳入2018-06—2021-06张家口市第一医院收治的98例颈内动脉-后交通动脉瘤伴动眼神经麻痹患者,对照组47例采用传统方式栓塞治疗,研究组51... 目的分析颈内动脉-后交通动脉瘤伴动眼神经麻痹患者采用大弹簧圈技术栓塞治疗的效果及安全性。方法纳入2018-06—2021-06张家口市第一医院收治的98例颈内动脉-后交通动脉瘤伴动眼神经麻痹患者,对照组47例采用传统方式栓塞治疗,研究组51例采用大弹簧圈技术栓塞治疗。比较2组术后Raymond-Roy分级、动脉瘤填塞密度、动脉瘤复发、术后动眼神经恢复情况、动脉瘤术后GOS评分、术后并发症。结果研究组Raymond-Roy分级优于对照组(P<0.05)。研究组弹簧圈填塞密度高于对照组(P<0.05),动脉瘤复发率低于对照组(P<0.05)。研究组动眼神经恢复情况、发生死亡、植物生存、重残、轻残的情况与对照组相比无统计学差异(P>0.05),研究组恢复良好占比高于对照组(P<0.05)。2组术后并发症发生率无统计学差异(P>0.05)。研究组弹簧圈用量及弹簧圈费用均低于对照组(P<0.05)。结论大弹簧圈技术用于颈内动脉-后交通动脉瘤伴动眼神经麻痹患者的效果显著,能有效提高栓塞程度及密度,降低动脉瘤复发率,改善患者预后,安全性高,且能降低医疗费用。 展开更多
关键词 颈内动脉-后交通动脉瘤 颅内动脉瘤 动眼神经麻痹 大弹簧圈技术 栓塞术
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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 被引量:9
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作者 周宇 杨鹏飞 +8 位作者 黄清海 许奕 洪波 赵文元 李强 方亦斌 赵瑞 杨志刚 刘建民 《中国脑血管病杂志》 CAS 2013年第10期512-517,共6页
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 ... 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. 展开更多
关键词 颅内动脉瘤 血管内操作 随访研究 血流导向装置 大型或巨大型动脉瘤
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支架辅助弹簧圈栓塞治疗颅内宽颈大型动脉瘤 被引量:14
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作者 曾少建 舒航 +3 位作者 陈光忠 詹升全 林晓风 周东 《中华神经外科疾病研究杂志》 CAS 2013年第2期167-170,共4页
目的探讨血管内支架结合可脱性弹簧圈治疗颅内宽颈大型动脉瘤的疗效、技术要点、安全性和并发症防治。方法回顾性总结我院自2008年5月至2012年5月经支架辅助进行栓塞的大型颅内动脉瘤13例。动脉瘤位置:后交通动脉瘤6例,颈内动脉海绵窦... 目的探讨血管内支架结合可脱性弹簧圈治疗颅内宽颈大型动脉瘤的疗效、技术要点、安全性和并发症防治。方法回顾性总结我院自2008年5月至2012年5月经支架辅助进行栓塞的大型颅内动脉瘤13例。动脉瘤位置:后交通动脉瘤6例,颈内动脉海绵窦段动脉瘤3例,大脑中动脉瘤2例,基底动脉瘤2例。结果所有病例栓塞操作均顺利完成,其中致密填塞9例,部分致密填塞4例,术后肢体出现偏瘫1例。本组有10例栓塞后3~17个月后进行造影随访,动脉瘤复发3例,2例给予补充填塞治疗,1例继续观察。结论支架辅助可脱性弹簧圈栓塞治疗大型颅内动脉瘤具有微创、安全、可靠、有效的优点,经验丰富的操作医师可将并发症降到最低点。 展开更多
关键词 颅内动脉瘤 大型 栓塞 支架 弹簧圈
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颅内巨大动脉瘤的手术治疗 被引量:6
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作者 黄理金 冯文峰 漆松涛 《南方医科大学学报》 CAS CSCD 北大核心 2012年第8期1214-1217,共4页
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... 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。 展开更多
关键词 巨大动脉瘤 显微手术 疗效
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颅内大型动脉瘤血管内治疗的长期随访 被引量:7
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作者 李志清 梁国标 +7 位作者 王晓刚 高旭 于春泳 张海峰 赵明利 许晓川 陈忠志 赖杰宇 《中国微侵袭神经外科杂志》 CAS 2015年第1期7-9,共3页
目的总结颅内大型动脉瘤血管内治疗的治疗策略、操作技巧和预后。方法回顾性分析血管内治疗的189例颅内大型和巨大动脉瘤病人的临床资料,其中闭塞载瘤动脉15例,单纯应用弹簧圈栓塞治疗27例,应用球囊辅助栓塞治疗48例,应用颅内自膨式辅... 目的总结颅内大型动脉瘤血管内治疗的治疗策略、操作技巧和预后。方法回顾性分析血管内治疗的189例颅内大型和巨大动脉瘤病人的临床资料,其中闭塞载瘤动脉15例,单纯应用弹簧圈栓塞治疗27例,应用球囊辅助栓塞治疗48例,应用颅内自膨式辅助栓塞治疗99例。结果 189例病人共行手术247次,动脉瘤首次治疗致密栓塞133例,次全栓塞35例,部分栓塞21例。其中47例病人行分期栓塞治疗。术后7例出现血栓栓塞症状,死亡1例,偏瘫4例,其余病人恢复良好。随访16个月~5年,所有病人无再出血。结论血管内治疗颅内大型和巨大动脉瘤是一种安全有效的方法,合理运用辅助手段可有助于减少并发症、降低复发率。 展开更多
关键词 颅内动脉瘤 大型 支架 球囊 弹簧圈 血管内治疗
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颅内巨大动脉瘤诊断及治疗 被引量:5
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作者 焦德让 只达石 +5 位作者 孙瑞发 尹龙 范一木 卫启明 黄楹 王实 《中国微侵袭神经外科杂志》 CAS 2000年第1期10-13,共4页
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... 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。 展开更多
关键词 颅内大动脉瘤 血管内治疗 诊断 治疗 CT MRI
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MR流动补偿技术在诊断颅内巨大动脉瘤中的价值 被引量:3
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作者 朱明旺 戴建平 +1 位作者 李少武 詹炯 《临床放射学杂志》 CSCD 北大核心 2002年第1期16-18,共3页
目的 观察MR流动补偿技术对颅内巨大动脉瘤MRI表现的影响 ,评价该技术在临床中的应用。资料与方法 搜集 35例经手术病理证实的颅内巨大动脉瘤 ,均行使用和未使用流动补偿技术T1WI检查 ,重点观察动脉瘤的残腔和血栓的MRI表现。结果 ... 目的 观察MR流动补偿技术对颅内巨大动脉瘤MRI表现的影响 ,评价该技术在临床中的应用。资料与方法 搜集 35例经手术病理证实的颅内巨大动脉瘤 ,均行使用和未使用流动补偿技术T1WI检查 ,重点观察动脉瘤的残腔和血栓的MRI表现。结果 颅内巨大动脉瘤的MR信号表现多样 ,主要与动脉瘤内是否出现血栓及其大小、形成时间的长短和动脉瘤引起的继发性改变等因素有关。使用流动补偿技术使残腔信号增高 ,有助于明确动脉瘤残腔的位置和大小。动脉瘤壁血栓信号差异很大 ,多呈层状或涡状的混杂信号。流动补偿技术对闭塞动脉瘤和瘤内血栓的信号没有影响。结论 MRI可清楚显示颅内巨大动脉瘤的残腔和血栓形成情况 ,使用流动补偿技术可以明确动脉瘤残腔的位置 ,提高诊断的特异性。 展开更多
关键词 磁共振 颅内巨大动脉瘤 流动补偿技术 诊断 MRI
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逆向抽空减压法治疗颅内巨大动脉瘤3例 被引量:3
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作者 刘相轸 李敬文 +1 位作者 陈会荣 林成海 《中国脑血管病杂志》 CAS 2004年第1期25-27,共3页
目的 探讨和评价逆向抽空减压法治疗颅内巨大动脉瘤的临床治疗效果。 方法采用逆向抽空减压法对3例颅内巨大动脉瘤患者进行手术治疗,并对其手术方法进行分析,对患者进行了随访。 结果对3例巨大动脉瘤均采用标准的翼点入路联合颈部颈动... 目的 探讨和评价逆向抽空减压法治疗颅内巨大动脉瘤的临床治疗效果。 方法采用逆向抽空减压法对3例颅内巨大动脉瘤患者进行手术治疗,并对其手术方法进行分析,对患者进行了随访。 结果对3例巨大动脉瘤均采用标准的翼点入路联合颈部颈动脉抽吸顺利夹闭。其中1例患者术后拒绝DSA复查,术后9个月随访患者偶有头晕,左眼视力略有好转,GOS(glasgowoutcome scale)预后分级为Ⅴ级;1例患者术后有左侧肢体不完全偏瘫,头颅CT显示右基底核缺血性改变,DSA复查示右颈部颈总动脉阻断处略狭窄,载瘤动脉通畅;术后6个月随访,GOS预后分级为Ⅳ级;另1例患者术后恢复良好,头颅CT复查显示动脉瘤夹闭完全,载瘤动脉显影良好;GOS预后分级为Ⅴ级。 结论逆向抽空减压法使部分不可直接夹闭或难以直接夹闭的颅内巨大动脉瘤变为可夹闭动脉瘤,是治疗颅内巨大动脉瘤安全有效的方法之一。 展开更多
关键词 逆向抽空减压法 颅内巨大动脉瘤 手术方法 手术治疗
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DSA血流定量分析软件评价血流导向装置治疗颅内大型动脉瘤的有效性 被引量:3
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作者 吴一娜 杨鹏飞 +4 位作者 方亦斌 韩静峰 Janina Beilner 黄清海 刘建民 《中国脑血管病杂志》 CAS 2013年第10期508-511,共4页
目的 探讨DSA血流定量分析软件评价血流导向装置治疗颅内大型动脉瘤后的血流特性改变,以分析血流导向装置治疗颅内大型动脉瘤的有效性.方法 回顾性分析2012年8月-2013年4月采用血流导向装置(Tubridge,Microport,上海)治疗的颅内大型... 目的 探讨DSA血流定量分析软件评价血流导向装置治疗颅内大型动脉瘤后的血流特性改变,以分析血流导向装置治疗颅内大型动脉瘤的有效性.方法 回顾性分析2012年8月-2013年4月采用血流导向装置(Tubridge,Microport,上海)治疗的颅内大型动脉瘤患者15例.以相同标准采集所纳入患者治疗前后常规造影图像,并通过DSA血流定量分析软件进行图像后处理,通过生成的时间密度曲线,分析载瘤动脉远端显影延迟时间、动脉瘤瘤体内血流达峰时间、瘤体内血流曲线下面积以及瘤体内血流最大斜率的变化情况.结果 本组患者的支架置入技术成功率为100%,通过DSA分析软件术后即刻分析发现,与术前相比,载瘤动脉远端延迟时间缩短中位数(M)1.031 s(范围0.324~2.143 s),动脉瘤瘤腔内血流曲线下面积(相对值)以及最大斜率(相对值)分别减少57±15和49±25.结论 Tubridge支架置入前后载瘤动脉远端显影时间延迟、瘤腔内血流曲线下面积及瘤腔内血流最大斜率的下降,证实采用血流定量分析方法评估血流导向装置对于颅内大型动脉瘤的即刻治疗效果是有效的,但其对于远期疗效的评估还有待进一步观察. 展开更多
关键词 颅内动脉瘤 大型 血流导向装置 血流定量分析
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显微手术治疗颅内巨大椎动脉瘤(附15例分析) 被引量:4
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作者 叶红星 袁贤瑞 +5 位作者 姜冰 王君宇 马志明 陈风华 万新 奚健 《临床神经外科杂志》 CAS 2008年第3期120-122,共3页
目的探讨颅内巨大椎动脉瘤的诊断及治疗方法。方法总结15例巨大椎动脉瘤的手术经验。瘤颈夹闭6例,椎动脉近端阻断2例,瘤壁塑形3例,孤立术3例,动脉瘤包裹1例。结果术后有13例进行了DSA和/或CTA检查,动脉瘤不显影者12例。15例患者术后1月... 目的探讨颅内巨大椎动脉瘤的诊断及治疗方法。方法总结15例巨大椎动脉瘤的手术经验。瘤颈夹闭6例,椎动脉近端阻断2例,瘤壁塑形3例,孤立术3例,动脉瘤包裹1例。结果术后有13例进行了DSA和/或CTA检查,动脉瘤不显影者12例。15例患者术后1月好(GOS4~5分)10例,差(GOS2~3分)4例,死亡1例。结论手术仍为巨大椎动脉瘤的首选治疗方法。应个性化设计治疗方案,据术中情况合理处理动脉瘤。 展开更多
关键词 巨大颅内动脉瘤 手术 椎动脉
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