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Analysis on Emergency Microsurgical Treatment for Cerebral Hernia Caused by Intracranial Anterior Circulation Aneurysm with Intracranial Hematoma
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作者 Gang Yang Junjie Lv +4 位作者 Shaojun Yang Chao Gu Chenbing Wang Lulu Weng Feng Ding 《Open Journal of Emergency Medicine》 2021年第3期49-59,共11页
<b><span style="font-family:Verdana;">Objective</span></b><span style="font-family:""><span style="font-family:Verdana;">: This study is to discus... <b><span style="font-family:Verdana;">Objective</span></b><span style="font-family:""><span style="font-family:Verdana;">: This study is to discuss CT performances and direct surgical strategy as well as therapeutic effect of patients who have rupture hemorrhage of intracranial anterior circulation aneurysm with complications of intracranial hematoma and cerebral hernia. </span><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;">: CT performances and treatment of 14 patients who have rupture hemorrhage of intracranial anterior circulation aneurysm with complications of intracranial hematoma and cerebral hernia in our hospital from March, 2019 to March, 2021 were reviewed. The relationship between hematoma caused by intracranial anterior circulation aneurysm and position of the aneurysm was analyzed. Besides, surgical</span><span><span style="font-family:Verdana;"> processing keys were discussed. </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: For all selected patients</span></span><span style="font-family:Verdana;">, intracranial hemorrhage is proved to be caused by rupture of aneurysm. Among them, there are 2 cases of anterior communicating aneurysms, 3 cases of posterior communicating aneurysms, and 9 cases of middle cerebral aneurysms.</span><span style="font-family:Verdana;"> According to exploration, we found 1 case of multiple </span><span style="font-family:Verdana;">aneurysm, which is the combination of a middle cerebral aneurysm (the responsible aneurysm) and ipsilateral posterior communicating aneurysm. There were two cases of intraoperative rupture. In this study, 3 patients died. According to GOS grading at 3 months after the operation, there were 1 case of V-grade (good recovery), 3 cases of IV-grade (self-maintenance), 5 cases of III-grade (severe disabled), 2 cases of II-grade (persistent vegetative state) and 3 cases of I-grade (died). </span><b><span style="font-family:Verdana;">Conclusions</span></b><span style="font-family:Verdana;">: Emergency microsurgical treatment can lower </span><span style="font-family:Verdana;">the death rate of cerebral hernia caused by intracranial </span><span style="font-family:Verdana;">anterior circulation aneurysm with intracranial hematoma and recover the neurological functions to the maximum extent. 展开更多
关键词 anterior circulation aneurysm intracranial Hematoma Cerebral Hernia MICROSURGERY
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Ruptured intracranial aneurysm presenting as cerebral circulation insufficiency:A case report 被引量:1
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作者 Long Zhao Shuang-Quan Zhao Xiao-Ping Tang 《World Journal of Clinical Cases》 SCIE 2021年第22期6380-6387,共8页
BACKGROUND Rupture of an intracranial aneurysm is a type of acute stroke that is a serious threat to human health.Misdiagnosis of ruptured intracranial aneurysms is a serious clinical event that may have disastrous co... BACKGROUND Rupture of an intracranial aneurysm is a type of acute stroke that is a serious threat to human health.Misdiagnosis of ruptured intracranial aneurysms is a serious clinical event that may have disastrous consequences in some patients.To date,ruptured intracranial aneurysms have been misdiagnosed as meningitis,tumors,stroke,or trauma,among other conditions.Here,we report what appears to be the first case of a ruptured intracranial aneurysm that presented as cerebral circulation insufficiency.CASE SUMMARY A middle-aged man was admitted to our hospital because of a parasellar lesion identified on a noncontrast computed tomography(CT)image after a mild traffic accident that was caused by a brief loss of consciousness.Notably,he was diagnosed with cerebral circulation insufficiency after two unexplained episodes of a transient loss of consciousness within the past 8 mo.The patient was diagnosed with right internal carotid artery aneurysm based on CT angiography and completely recovered after a craniotomy at our hospital.A few clots and severe adhesions around the aneurysm were observed in the subarachnoid space during the operation,suggesting that the aneurysm had ruptured and may had been misdiagnosed as cerebral circulation insufficiency.CONCLUSION Ruptured intracranial aneurysms may show negative imaging results and present as cerebral circulation insufficiency,which should be recognized as soon as possible to ensure timely management. 展开更多
关键词 intracranial aneurysm MISDIAGNOSIS Cerebral circulation insufficiency CASE
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Different strategies for ultra-early reperfusion therapy in anterior circulation acute ischemic stroke safety and effectiveness of the comparative observation
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作者 Wen-Jing Zhou Lu Yang +5 位作者 Yan-Chao Huo Meng Geng Meng Zhang Chuan-Hui Li Na Shang Yao-Ming Xu 《Clinical Research Communications》 2023年第2期33-38,共6页
Background:To compare the safety and effectiveness of direct mechanical thrombectomy and bridging therapy for stroke with acute anterior circulation large vessel occlusion within 4.5 hours of onset.Methods:Retrospecti... Background:To compare the safety and effectiveness of direct mechanical thrombectomy and bridging therapy for stroke with acute anterior circulation large vessel occlusion within 4.5 hours of onset.Methods:Retrospectively collected from 66 patients with acute ischemic stroke admitted to the Department of Neurology of Tongliao Hospital and Xuanwu Hospital from August 2019 to November 2021 within 4.5 hours.According to the different recanalization methods,30 patients were assigned to the direct thrombectomy treatment group,and 36 patients in the bridging treatment group(i.e.,the intravenous thrombolysis bridging mechanical thrombectomy treatment group).The primary outcome measure was the neurological outcome at the onset of 90d.Secondary outcome measures were intraoperative vascular recanalization and reperfusion,and the US National Institute of Health Stroke Scale score at 24 hours after surgery.The primary safety indicators are intracranial hemorrhage,including symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage,and 90d mortality.Results:The direct thrombectomy group had lower body mass index,hypertension and baseline Alberta early computed tomography score than the bridging treatment group,and longer time from onset to visit than the bridging group(206.5(119.5,256.25)min vs.150.5(25.205,212.75)min),the above difference were statistically significant(P<0.05).There were no significant differences in successful vascular reperfusion(93%vs.89%),24 hours postoperative National Institute of Health Stroke Scale score(11(5,18)vs.11(5,20)),intracranial hemorrhage(11%vs.14%),symptomatic intracranial hemorrhage(7%vs.17%),90d mRS0 to 2 points(43%vs.36%)and 90d mortality(23%vs.22%)(P>0.05).Conclusion:Similar clinical efficacy and safety of direct mechanical thrombectomy and bridging therapy for acute anterior circulation large vessel occlusive stroke within 4.5 hours of onset,direct thrombectomy can be used as an alternative scheme for acute anterior circulation intracranial large artery occlusive stroke. 展开更多
关键词 anterior circulation direct thrombectomy therapy bridging therapy intracranial large vessel occlusion acute ischemic stroke
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Endovascular treatment of ruptured lobulated anterior communicating artery aneurysms:A retrospective study of 24 patients
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作者 Sheng-Xuan Huang Xun-Ping Ai +4 位作者 Ze-Hui Kang Zhi-Yong Chen Ren-Man Li Zu-Chao Wu Feng Zhu 《World Journal of Clinical Cases》 SCIE 2024年第15期2529-2541,共13页
BACKGROUND Lobulated intracranial aneurysm is a special type of aneurysm with at least one additional cyst in the neck or body of the aneurysm.Lobulated intracranial aneurysm is a complex aneurysm with complex morphol... BACKGROUND Lobulated intracranial aneurysm is a special type of aneurysm with at least one additional cyst in the neck or body of the aneurysm.Lobulated intracranial aneurysm is a complex aneurysm with complex morphology and structure and weak tumor wall,which is an independent risk factor for rupture and hemorrhage.Lobular aneurysms located in the anterior communicating artery complex account for 36.9%of all intracranial lobular aneurysms.Due to its special anatomical structure,both craniotomy and endovascular treatment are more difficult.Compared with single-capsule aneurysms,craniotomy for lobular intracranial aneurysms has a higher risk and complication rate.AIM To investigate the efficacy and safety of endovascular treatment for ruptured lobulated anterior communicating artery aneurysm(ACoAA).METHODS Patients with ruptured lobulated ACoAA received endovascular treatment in Sanming First Hospital Affiliated to Fujian Medical University from June 2020 to June 2022 were retrospectively included.Their demographic,clinical and imaging characteristics,endovascular treatment methods and follow-up results were collected.RESULTS A total of 24 patients with ruptured lobulated ACoAA were included,including 9 males(37.5%)and 15 females(62.5%).Their age was 56.2±8.9 years old(range 39-74).The time from rupture to endovascular treatment was 10.9±12.5 h.The maximum diameter of the aneurysms was 5.1±1.0 mm and neck width were 3.0±0.7 mm.Nineteen patients(79.2%)were double-lobed and 5(20.8%)were multilobed.Fisher's grade:Grade 2 in 16 cases(66.7%),grade 3 in 6 cases(25%),and grade 4 in 2 cases(8.3%).Hunt-Hess grade:Grade 0-2 in 5 cases(20.8%),grade 3-5 in 19 cases(79.2%).Glasgow Coma Scale score:9-12 in 14 cases(58.3%),13-15 in 10 cases(41.7%).Immediately postprocedural Raymond-Roy grade:grade 1 in 23 cases(95.8%),grade 2 in 1 case(4.2%).Raymond-Roy grade in imaging follow-up for 2 wk to 3 months:grade 1 in 23 cases(95.8%),grade 2 in 1 case(4.2%).Followup for 2 to 12 months showed that 21 patients(87.5%)had good functional outcomes(modified Rankin Scale score≤2),and there were no deaths.CONCLUSION Endovascular treatment is a safe and effective treatment for ruptured lobulated AcoAA. 展开更多
关键词 intracranial aneurysm anterior cerebral artery Endovascular surgery EMBOLISM Treatment outcome
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Clipping versus coiling in posterior circulation intracranial aneurysms: a meta-analysis
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作者 Eleni Tsianaka Abdullah Al-Shawish +3 位作者 Alexander Potapov Kostas Fountas Michael Spyrou Nikolay Konovalov 《Chinese Neurosurgical Journal》 CSCD 2019年第3期151-162,共12页
Posterior circulation intracranial aneurysm (IA) treatment remains challenging, due to the anatomy of the area and the high rupture possibility. Endovascular treatment seems to be more suitable for these aneurysms, bu... Posterior circulation intracranial aneurysm (IA) treatment remains challenging, due to the anatomy of the area and the high rupture possibility. Endovascular treatment seems to be more suitable for these aneurysms, but studies focused on endovascular treatment demonstrate a high rate of re-intervention needing. A meta-analysis might offer a clearer view, being useful in a more effective treatment planning. Methods: A systematic search was performed, using the PubMed database platform. The final article pool contained 20 articles. Studied parameters were operative mortality, late mortality, permanent neurologic deficit (PND), and the need for re-intervention (Re-int). We divided patients into two subgroups, those with ruptured and those with unruptured aneurysm. Statistical analysis was performed using appropriate software. Results: In the total population (645 patients), there was a superiority of coiling over clipping in terms of PND and of coiling in terms of Re-int. As regards mortality, there was no clear superiority of one method over the other. Conclusions: The current study came to the conclusion that there is a superiority of coiling over clipping in terms of PND. On the other hand, clipping seems to be superior to coiling in terms of the need for re-intervention. As regards mortality (both operative and late), there is no clear superiority of one method over the other. Studying subgroups of patients (ruptured and unruptured posterior circulation IAs), in terms of PND, there is no superiority of one method over the other. The same goes for Op-Mo on ruptured aneurysms. 展开更多
关键词 CLIPPING COILING intracranial aneurysmS META-ANALYSIS POSTERIOR circulation
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Clipping versus Coiling in Ruptured Aneurysms of the Anterior Cerebral Circulation
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作者 Farrag Mohammad Takashi Horiguchi +1 位作者 Katsuhiro Mizutani Kazunari Yoshida 《Open Journal of Modern Neurosurgery》 2020年第1期88-104,共17页
Objective: To evaluate and compare the outcomes of microsurgical clipping and endovascular coiling of ruptured anterior cerebral circulation aneurysms. Methods: The current study retrospectively included 61 patients p... Objective: To evaluate and compare the outcomes of microsurgical clipping and endovascular coiling of ruptured anterior cerebral circulation aneurysms. Methods: The current study retrospectively included 61 patients presented with subarachnoid hemorrhage (SAH), treated by clipping or coiling for ruptured aneurysms located in anterior circulation. Anatomic outcome and post-operative ischemic events were evaluated. The primary clinical outcomes were evaluated as operative complications while the secondary clinical outcome was evaluated by modified Rankin scale (mRS) at discharge. Results: Of 61 ruptured aneurysms, 47 and 14 were treated by surgery and coiling, respectively. The average follow-up duration was 19.1 ± 18.6 months for clipping and 21.7 ± 14.8 months for coiling. Complete occlusion was greater in surgery group (80.8%) than endovascular group (21.4%). Re-growth occurred in 2 cases of the coiling group only. Ischemic events were encountered in both groups;silent ones were higher in coiling group (21.4%) than in clipping group (6.3%), while symptomatic ones were higher in the clipping group (49%). Good outcome (mRS 0 - 2) was 51% and 71.4% after clipping and coiling respectively. Postoperative hospital period was longer after clipping (P = 0.04). Conclusions: For anterior circulation ruptured aneurysms, both treatments are feasible, coiling showed lower rate of morbidity while clipping results were better regarding durability and recurrence. Coil embolization may be preferred, which is the current point proved by the RCT like ISAT, but if you choose the patients carefully and find out the optimal candidate for the clipping, the clipping is still enough feasible as a mainstream. 展开更多
关键词 anterior circulation SAH CLIPPING COILING RUPTURED aneurysmS
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Hemodynamic consideration of intracranial aneurysm
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作者 Hiroshi Ujiie Chie Shinohara +2 位作者 Yoshinori Tamano Kouichi Katou Akira Teramoto 《Translational Neuroscience and Clinics》 2017年第4期229-236,共8页
We reviewed basic considerations in fluid dynamics of cerebral aneurysms and applied these in surgery on the three most common types: internal carotid-posterior communicating artery,middle cerebral artery,and anterior... We reviewed basic considerations in fluid dynamics of cerebral aneurysms and applied these in surgery on the three most common types: internal carotid-posterior communicating artery,middle cerebral artery,and anterior communicating artery. It was found that aneurysmal initiation and growth do not occur at symmetric bifurcations. As blood flow always obeys the law of inertia,jet flow into the aneurysm will disperse along the wall; assuming the aneurysmal wall strength is even,the shape of the aneurysm becomes round or oval. When neurosurgeons encounter an aneurysm that is not round or oval,the wall may be fragile and requires great care during surgical manipulation. 展开更多
关键词 intracranial aneurysm subarachnoid hemorrhage computational fluid dynamics shear stress partial epilepsy middle cerebral artery internal carotid artery anterior cerebral artery
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Influence of Clip Locations on Intraaneurysmal Flow Dynamics in Patient-specific Anterior Communicating Aneurysm Models with Different Aneurysmal Angle 被引量:2
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作者 Lizhong Mu Qingzhuo Chi +2 位作者 Changjin Ji Ying He Ge Gao 《Computer Modeling in Engineering & Sciences》 SCIE EI 2018年第8期175-197,共23页
To improve aneurysm treatment,this study examined the influence of clip locations on hemodynamic factors in patient-specific anterior communicating artery(ACoA)aneurysms with different aneurysmal angle.We proposed a s... To improve aneurysm treatment,this study examined the influence of clip locations on hemodynamic factors in patient-specific anterior communicating artery(ACoA)aneurysms with different aneurysmal angle.We proposed a simplified classification of ACoA aneurysms using aneurysmal angle,defined by the angle of pivot of the aneurysmal dome and the virtual two-dimensional plane created by both proximal A2 segments of anterior cerebral artery(ACA).ACoA aneurysms with three different aneurysmal angles,which are 15°,80°and 120°,were analyzed in our study.In this work,we obtained hemodynamics before and after clipping surgery with three clip locations based on clinical clipping strategies in three ACoA aneurysms with different aneurysm angles.Results showed that local high pressure occurs at impingement region of the ACoA aneurysm before clipping and new impingement region close to the clipping location after clipping treatment.For clipping the aneurysm with aneurysmal angle 15°and a wide neck,wall shear stress(WSS)distribution is more uniform when the clipping angle of two clips close to 180°comparing with other two angles.In addition,for clipping the aneurysm with aneurysmal angle 80°and 120°,local high pressure appears on new impingement region and high WSS distributes around the clipping location when the clip plane is normal to the direction of inflow of aneurysm from the dominance of A1 segment of ACA.Hence,we should avoid the impingement of inflow from the A1 segment and choose a favorable clipping location for the fastness of clip.The results of our study could preoperatively give a useful information to the decision of surgical plan. 展开更多
关键词 intracranial aneurysm anterior COMMUNICATING artery surgical CLIPPING treatment PATIENT-SPECIFIC model intraaneurysmal flow dynamics
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颅内-颅内血管搭桥侧侧吻合术治疗复杂颅内动脉瘤长期疗效观察
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作者 刘源 佟志勇 +2 位作者 余冠东 赵旭东 初金刚 《中国现代神经疾病杂志》 CAS 北大核心 2024年第8期632-643,共12页
目的 探讨颅内-颅内血管搭桥侧侧吻合术治疗复杂颅内动脉瘤的长期疗效。方法 纳入2015年1月至2023年12月由中国医科大学附属第一医院神经外科同一术者实施颅内-颅内血管搭桥侧侧吻合术的5例复杂颅内动脉瘤患者,2例累及大脑前动脉A2段,3... 目的 探讨颅内-颅内血管搭桥侧侧吻合术治疗复杂颅内动脉瘤的长期疗效。方法 纳入2015年1月至2023年12月由中国医科大学附属第一医院神经外科同一术者实施颅内-颅内血管搭桥侧侧吻合术的5例复杂颅内动脉瘤患者,2例累及大脑前动脉A2段,3例累及大脑中动脉M2段。术中采用吲哚菁绿荧光血管造影术(ICGA)、术后采用CTA或DSA评估动脉瘤闭塞和血流重建情况;术后1周、3个月和末次随访时采用改良Rankin量表(mRS)评估神经功能预后;术后第1天、1周和3个月行头部CT和(或)MRI检查,评估是否发生出血性或缺血性并发症。结果 本组5例复杂颅内动脉瘤均孤立确切,2例行A3-A3侧侧吻合术;3例行M2-M2侧侧吻合术,其中1例在M2-M2侧侧吻合术基础上获取桡动脉(RA)作为桥血管,联合M1-RA-M2嵌入桥接式血管搭桥术。术中经ICGA证实,5例侧侧吻合口和1例M1-RA-M2桥血管均通畅。术后随访时间为23(14,71)个月,5例术后1周和术后3个月CTA或DSA检查、3例术后9~12个月DSA检查均未见动脉瘤显影,5例侧侧吻合口和1例M1-RA-M2桥血管均通畅。术后1周mRS评分较术前升高0~3分(1例手术前后均为4分、1例增加2分、1例增加3分),2例未破裂患者术后1周mRS评分无变化(均为1分);术后3个月mRS评分均下降(0分2例、2分1例、3分2例);末次随访时1例失访,余4例mRS评分进一步下降(0分2例、1分1例、2分1例)。术后无脑出血或脑缺血事件发生。结论 颅内-颅内血管搭桥侧侧吻合术的短期和长期通畅性良好,长期疗效稳定,是复杂颅内动脉瘤手术治疗的可靠技术。 展开更多
关键词 颅内动脉瘤 大脑前动脉 大脑中动脉 脑血管重建术 颅内-颅内(非MeSH词) 侧侧吻合(非MeSH词)
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显微手术夹闭治疗前循环破裂动脉瘤的预后影响因素
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作者 陈泽鑫 王育胜 +2 位作者 林楚纯 蔡跃豪 袁军 《国际医药卫生导报》 2024年第15期2506-2510,共5页
目的探讨影响显微手术夹闭治疗前循环破裂动脉瘤预后的因素。方法回顾性选取2018年1月至2023年6月揭阳市人民医院收治的80例前循环破裂动脉瘤患者,男38例、女42例,年龄(53.28±2.81)岁,入院至手术时间(1.96±0.52)d,临床表现:... 目的探讨影响显微手术夹闭治疗前循环破裂动脉瘤预后的因素。方法回顾性选取2018年1月至2023年6月揭阳市人民医院收治的80例前循环破裂动脉瘤患者,男38例、女42例,年龄(53.28±2.81)岁,入院至手术时间(1.96±0.52)d,临床表现:剧烈头痛48例,轻度头痛31例,意识障碍26例。所有患者均行显微手术夹闭治疗,根据预后分为预后良好组与预后不良组,术后随访6个月,分析其临床资料,应用格拉斯哥预后量表(GOS)对患者预后进行评估,采用χ^(2)检验,以logistic回归方程分析影响预后的相关因素。结果80例患者均随访成功,其中预后良好59例(73.75%),预后不良21例(26.25%);两组年龄、性别、动脉瘤长径、手术时间、出血次数、入院至手术时间比较,差异均无统计学意义(均P>0.05);logistic分析结果显示,术前Hunt-Hess分级、格拉斯哥昏迷量表(GCS)评分、术后脑血管并发症、术后颅内感染、Fisher分级为影响前循环破裂动脉瘤患者预后的危险因素(均P<0.05)。结论影响显微手术夹闭治疗前循环破裂动脉瘤患者预后的因素较多,主要与术前Hunt-Hess分级、GCS评分、术后颅内感染等密切相关。 展开更多
关键词 前循环破裂动脉瘤 显微手术夹闭 预后 影响因素
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探讨前循环症状性颅内动脉狭窄患者支架成形术联合药物治疗的有效性与安全性
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作者 梁建锋 《智慧健康》 2024年第5期71-73,77,共4页
目的 分析前循环症状性颅内动脉狭窄患者支架成形术+药物治疗的效果。方法 选取2018年1月—2022年12月本院前循环症状性颅内动脉狭窄患者100例为研究对象,随机分成为对照组、观察组(各50例)。对照组采取药物治疗方案,观察组联合支架成... 目的 分析前循环症状性颅内动脉狭窄患者支架成形术+药物治疗的效果。方法 选取2018年1月—2022年12月本院前循环症状性颅内动脉狭窄患者100例为研究对象,随机分成为对照组、观察组(各50例)。对照组采取药物治疗方案,观察组联合支架成形术与药物治疗,比较两组的治疗效果。结果 观察组治疗后的NHISS评分、改良Rankin评分均低于对照组(P<0.05);观察组的rCBF、rCBV高于对照组(P<0.05);观察组生活质量评分高于对照组(P<0.05)。结论 针对前循环症状性颅内动脉狭窄患者,治疗时采取支架成形术和药物相结合的方式,能够获得良好的治疗效果,可改善其局部脑血灌注指标,患者的预后效果也较好。 展开更多
关键词 前循环症状性颅内动脉狭窄 支架成形术 药物治疗 有效性 安全性
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前交通动脉动脉瘤112例诊治真实世界数据分析:单中心报告
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作者 唐必英 李钢 +4 位作者 刘珍 乔卫东 王辉 刘成业 肖仕和 《中国微侵袭神经外科杂志》 CAS 2024年第4期203-208,共6页
目的对前交通动脉动脉瘤(anterior communicating artery aneurysm,ACoAA)病例资料进行真实世界数据(real world data,RWD)分析,总结救治经验。方法回顾性分析112例ACoAA病例资料。男69例,女43例,年龄30~80岁、平均(45.00±11.05)... 目的对前交通动脉动脉瘤(anterior communicating artery aneurysm,ACoAA)病例资料进行真实世界数据(real world data,RWD)分析,总结救治经验。方法回顾性分析112例ACoAA病例资料。男69例,女43例,年龄30~80岁、平均(45.00±11.05)岁。发生蛛网膜下腔出血就诊110例,未破裂就诊2例。行开颅夹闭66例,血管内介入治疗46例,其中应用支架辅助栓塞5例。统计病人的人口学资料、基础疾病、个人史、家族史、入院状况及影像学资料、动脉瘤解剖学特征、病人预后等资料。结果依据改良Rankin量表(modified Rankin Scale,mRS)评分:良好(mRS 0~2分)82例,残疾(mRS 3~5分)22例,死亡(mRS 6)8例。RWD将预后不良的相关因素,纳入有序多分类Logistic回归分析,显示年龄与饮酒史是ACoAA术后预后的独立危险因素,病人居住地、高血压病史及不同治疗术式(开颅夹闭和栓塞治疗)不是病人预后的独立危险因素。结论ACoAA确诊后接受积极治疗(开颅夹闭或栓塞治疗),病人术后恢复良好率较高。ACoAA不良预后可能与年龄、饮酒等因素相关。 展开更多
关键词 颅内动脉瘤 前交通复合体 真实世界数据 动脉瘤夹闭术 动脉瘤栓塞术
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血流导向装置治疗大脑前动脉动脉瘤的安全性及疗效分析
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作者 马武林 安梦思 +2 位作者 刘烁 管生 郭新宾 《介入放射学杂志》 CSCD 北大核心 2024年第7期711-716,共6页
目的 探讨血流导向装置(FD)治疗大脑前动脉动脉瘤的安全性和疗效。方法 回顾性分析2019年2月至2022年8月郑州大学第一附属医院神经介入科收治的FD治疗大脑前动脉动脉瘤24例。术后采用O'Kelly Marotta(OKM)分级标准判断动脉瘤的闭塞... 目的 探讨血流导向装置(FD)治疗大脑前动脉动脉瘤的安全性和疗效。方法 回顾性分析2019年2月至2022年8月郑州大学第一附属医院神经介入科收治的FD治疗大脑前动脉动脉瘤24例。术后采用O'Kelly Marotta(OKM)分级标准判断动脉瘤的闭塞程度,采用改良Rankin量表评分(mRS)评估临床预后(0~2分为预后良好,3~5分为预后不良)。结果 24例患者(24枚动脉瘤)共置入24枚支架,支架置入成功率为100%。围手术期发生2例(8.3%)并发症,1例为出血性事件,1例为缺血性事件。术后随访24例患者中mRS评分均≤2分。随访中24例患者经影像学检查,OKM分级B级2例(8.3%),C级6例(25%),其余16例(66.7%)患者完全愈合(D级)。结论FD是一种安全和有效的治疗大脑前动脉动脉瘤的方式。术后和长期随访结果中没有严重的缺血性或出血性并发症,也没有观察到神经病学并发症。 展开更多
关键词 血流导向装置 颅内动脉瘤 大脑前动脉
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眶上额外侧入路开颅夹闭术治疗前循环动脉瘤破裂的临床效果
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作者 蔡沉逐 郭协力 +2 位作者 王佳音 齐震 蔡明发 《中国医学创新》 CAS 2024年第28期52-56,共5页
目的:探究眶上额外侧入路开颅夹闭术治疗前循环动脉瘤破裂的临床效果。方法:将2020年1月—2023年12月于晋江市医院进行开颅夹闭治疗的前循环动脉瘤破裂患者100例根据随机数字表法分为对照组(n=50)和观察组(n=50)。对照组进行翼点入路开... 目的:探究眶上额外侧入路开颅夹闭术治疗前循环动脉瘤破裂的临床效果。方法:将2020年1月—2023年12月于晋江市医院进行开颅夹闭治疗的前循环动脉瘤破裂患者100例根据随机数字表法分为对照组(n=50)和观察组(n=50)。对照组进行翼点入路开颅夹闭治疗,观察组进行眶上额外侧入路开颅夹闭治疗。比较两组治疗效果、术中出血量、手术时间、住院时间、并发症发生率,以及手术前后神经功能评分[美国国立卫生研究院卒中量表(NIHSS)评分]、神经损伤指标[神经元特异性烯醇化酶(NSE)、S100钙结合蛋白B(S100B)及髓鞘碱性蛋白(MBP)]、创伤应激指标[β-内啡肽(β-EP)、白介素-6(IL-6)及强啡肽A1-13(DynA1-13)]。结果:术后3个月,观察组总有效率显著高于对照组,术中出血量显著少于对照组,手术时间及住院时间均显著短于对照组,差异均有统计学意义(P<0.05)。两组并发症发生率比较,差异均无统计学意义(P>0.05)。术前两组NIHSS评分、神经损伤指标及创伤应激指标比较,差异均无统计学意义(P>0.05),术后7 d,观察组NIHSS评分、神经损伤指标及创伤应激指标均显著低于对照组,差异均有统计学意义(P<0.05)。结论:眶上额外侧入路开颅夹闭治疗前循环动脉瘤破裂的临床效果较好,其可有效控制神经损伤及机体创伤应激,促进患者术后恢复。 展开更多
关键词 眶上额外侧入路 翼点入路 开颅夹闭 前循环动脉瘤破裂
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前循环动脉瘤夹闭术后迟发性脑缺血情况及影响因素分析
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作者 吕光淘 孙凌云 +2 位作者 黄小龙 黄浩 张晓强 《临床神经病学杂志》 CAS 2024年第5期366-371,共6页
目的探究前循环动脉瘤患者行夹闭术后发生迟发性脑缺血(DCI)情况及其影响因素。方法回顾性分析2018年5月至2023年5月本院采用夹闭术方式救治的前循环动脉瘤患者248例,根据术后DCI的发生与否分为DCI组和非DCI组,采用1∶1倾向性评分方法... 目的探究前循环动脉瘤患者行夹闭术后发生迟发性脑缺血(DCI)情况及其影响因素。方法回顾性分析2018年5月至2023年5月本院采用夹闭术方式救治的前循环动脉瘤患者248例,根据术后DCI的发生与否分为DCI组和非DCI组,采用1∶1倾向性评分方法匹配后DCI和非DCI组各54例。采用随机森林算法对DCI影响因素进行重要性排序,多因素Logistic回归模型分析DCI的独立危险因素,E值法分析模型参数的敏感性。构建DCI风险预测模型,采用ROC曲线、Hosmer-Lemeshow检验评价模型的区分度和准确性。结果匹配后两组患者在性别、年龄、身体质量指数(BMI)、吸烟史、饮酒史、脑梗死病史、蛛网膜下腔出血史、动脉瘤位置、动脉瘤最大直径方面差异均无统计学意义(均P>0.05)。与非DCI组患者相比,DCI患者改良Fisher 3~4级、Hunt-HessⅣ级患者比率更高,D二聚体(D-D)、总胆红素(TBIL)、TNF-α、超敏C反应蛋白(hs-CRP)、IL-6、谷氨酸水平更高,免疫球蛋白(Ig)G、IgM、IgA水平更低(均P<0.05)。随机森林算法分析结果显示将Hunt-Hess分级、改良Fisher分级、D-D、谷氨酸、TBIL、IgA、IL-6纳入多因素回归分析获得的袋外数据错误率最低。多因素分析发现,Hunt-HessⅣ级、改良Fisher 3~4级、D-D、谷氨酸、TBIL、IL-6为DCI的独立危险因素,IgA为保护因素(均P<0.05)。风险预测方程:P=1/[1+e^((3.142+1.307 Hunt-Hess分级+1.086改良Fisher分级+0.976 D-D+0.748)谷氨酸+0.552 TBIL-0.524 IgA+0.487 IL-6)],当P>0.65时认为该患者术后发生DCI。ROC曲线结果显示,模型经内部验证后,AUC为0.869(95%CI:0.836~0.897),敏感度和特异度分别为81.08%和97.34%,模型具有良好的区分度。Hosmer-Lemeshow检验结果显示,模型经内部验证后拟合优度为χ^(2)=4.219,P=0.561,模型具有良好的拟合优度。结论Hunt-HessⅣ级、改良Fisher 3~4级、D-D、谷氨酸、TBIL、IL-6为DCI的独立危险因素,IgA为保护因素。由以上因素构建的预测模型具有较高的准确度和区分度,当风险概率P>0.65时认为该患者术后会发生DCI。 展开更多
关键词 前循环动脉瘤 夹闭术 迟发性脑缺血 蛛网膜下腔出血 免疫
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血流导向装置在颅内前循环破裂动脉瘤中的应用效果
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作者 杨巧钰 罗针 +2 位作者 赵小燕 李昌泰 杨威 《中国实用神经疾病杂志》 2024年第1期9-14,共6页
目的分析血流导向装置在颅内前循环破裂动脉瘤中的应用效果。方法选取2019-10—2022-10华西医院收治的84例颅内前循环破裂动脉瘤患者为研究对象,采用随机数字表法分为观察组42例与对照组42例。对照组患者采用开颅夹闭术治疗,观察组患者... 目的分析血流导向装置在颅内前循环破裂动脉瘤中的应用效果。方法选取2019-10—2022-10华西医院收治的84例颅内前循环破裂动脉瘤患者为研究对象,采用随机数字表法分为观察组42例与对照组42例。对照组患者采用开颅夹闭术治疗,观察组患者采用血流导向装置治疗,随访6个月,比较2组患者手术情况、恢复效果、相关血清学指标以及并发症发生率。结果观察组患者手术结束时OKM分级[(3.82±0.05)分]、术后6个月GOS评分[(4.23±0.45)分]、术后24 h GCS评分[(15.18±2.79)分]高于对照组[分别为(3.67±0.08)分、(3.71±0.58)分、(12.36±2.54)分],住院时间[(17.21±3.87)d]短于对照组[(24.36±5.25)d],术后6个月血清Caspase-3[(157.38±45.15)μg/L]、MMP-9水平[(12.83±2.41)μg/L]及总并发症发生率(9.52%)均低于对照组[分别为(294.76±58.43)μg/L、(18.62±3.58)μg/L、26.19%],差异均有统计学意义(P<0.05)。结论颅内前循环破裂动脉瘤患者应用血流导向装置能够显著提升栓塞效果,改善血清学指标和预后,缩短住院时间,降低并发症发生率。 展开更多
关键词 动脉瘤 前循环 破裂动脉瘤 动脉瘤栓塞术 血流导向装置 开颅夹闭术
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三维螺旋CT血管成像与三维数字减影血管造影诊断颅内动脉瘤的价值
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作者 李济民 杨雪丽 陈鹏 《四川生理科学杂志》 2024年第11期2509-2511,共3页
目的:探讨三维CT血管造影(Three-dimensional computed tomographic angiography,3D-CTA)与三维数字减影血管造影(Three-dimensional digital subtraction angiography,3D-DSA)诊断颅内动脉瘤的价值。方法:选择我院收治的疑似颅内动脉... 目的:探讨三维CT血管造影(Three-dimensional computed tomographic angiography,3D-CTA)与三维数字减影血管造影(Three-dimensional digital subtraction angiography,3D-DSA)诊断颅内动脉瘤的价值。方法:选择我院收治的疑似颅内动脉瘤患者进行回顾性分析,病例数共110例,病例选取时间为2021年4月至2023年9月。所有患者均进行3D-CTA与3D-DSA分析,对比两种检查方式的检查结果的一致性,瘤体最大直径与瘤颈径和3D-CTA对确诊的瘤体位置检出准确率。结果:两种检查方式对AN的检查结果一致性较好(Kappa=0.872,P<0.05),采用3D-CTA检出大脑前动脉、椎基底动脉检出符合率为100.00%,大脑中动脉66.67%,大脑后动脉为75.00%,前交通动脉为74.12%,后交通动脉为95.65%,颈内动脉颅内段为89.47%;3D-DSA与3D-CTA检查结果显示,两组瘤体最大直径、瘤颈径对比无统计学意义(P>0.05)。结论:与3D-DSA检查相比,3D-CTA其一致性较高,且对于瘤体不同位置的检出率均表现优异,值得临床推广。 展开更多
关键词 三维螺旋CT血管成像 三维数字减影血管造影 颅内动脉瘤 大脑前动脉
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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
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作者 曾永亲 史涛 +7 位作者 刘妲 张旭标 陈志杰 郭东亮 邓斌 王东 王国良 林涛 《中国微侵袭神经外科杂志》 CAS 2024年第7期414-419,共6页
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... 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。 展开更多
关键词 颅内动脉瘤 脉络膜前动脉 多辅助手段 显微外科手术
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3D Slicer三维重建辅助诊治大脑前动脉多发假性动脉瘤1例
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作者 何川 谭兴实 +3 位作者 钟琦 林晓鸿 陈尧坤 曹刚 《中国临床神经外科杂志》 2024年第7期446-448,共3页
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... 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。 展开更多
关键词 颅内创伤性假性动脉瘤 颅内多发动脉瘤 大脑前动脉 3D Slicer软件 三维重建技术
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介入栓塞术治疗前循环动脉瘤的临床疗效及对神经功能的影响
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作者 聂文 叶林 +2 位作者 陈森 刘娟 祁晓瑜 《中外医疗》 2024年第11期66-70,共5页
目的探讨介入栓塞术治疗前循环动脉瘤的临床疗效及对神经功能的影响。方法回顾性选取2022年2月—2023年4月同济大学附属东方医院胶州医院神经外科收治的80例前循环动脉瘤患者的临床资料。根据手术方式不同分为观察组(介入栓塞)与对照组... 目的探讨介入栓塞术治疗前循环动脉瘤的临床疗效及对神经功能的影响。方法回顾性选取2022年2月—2023年4月同济大学附属东方医院胶州医院神经外科收治的80例前循环动脉瘤患者的临床资料。根据手术方式不同分为观察组(介入栓塞)与对照组(显微动脉瘤夹闭术),各40例。比较两组手术持续时间及术后住院时间,比较两组手术前后钙结合蛋白B和神经元特异性烯醇化酶水平变化情况,统计两组并发症发生情况及半年内神经功能预后分级情况。结果观察组手术持续时间为(56.5±12.4)min,短于对照组,术后住院时间为(10.4±2.2)d,短于对照组,差异有统计学意义(P均<0.05)。术后,观察组钙结合蛋白B及神经元特异性烯醇化酶水平分别为(9.3±1.5)、(8.7±1.5)ng/mL,均显著高于对照组,差异有统计学意义(t=4.779、6.495、P均<0.05)。观察组颅内感染、动脉瘤破裂、脑梗死、短暂性脑血管痉挛及脑积水的总发生率(2.5%)显著低于对照组(15.0%),差异有统计学意义(χ^(2)=3.914,P<0.05),观察组的预后良好率高于对照组,病死率低于对照组,差异有统计学意义(P均<0.05)。结论介入栓塞术治疗前循环动脉瘤具有创伤小,术后神经功能恢复快,并发症少,安全性高,临床效果可靠的优势,对于促使患者早期出院有积极意义。 展开更多
关键词 介入栓塞术 开放夹闭术 前循环动脉瘤 临床预后 神经功能
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