瘤内及载瘤动脉闭塞治疗颅内巨大动脉瘤

巨大动脉瘤是指直径超过25mm的动脉瘤,约占颅内动脉瘤5%～7%,有人报告可达到20%以上。按其生长部位有手术指征的死亡率占5.6%～37.5%,各家报道不一。但亦有相当一部分生长于颈内动脉海绵窦段椎动脉颅颈交界处等部位,,手术风险难度极大,死亡率相当高为此笔者对此类病例通、。,过瘤内GDC或瘤内 载瘤动脉或单纯载瘤动脉可脱球囊闭塞等方法,成功治疗了例巨大型动脉瘤患者,现报告如下。41临床资料1.1一般资料男1例,女3例,年龄最小22岁,最大57岁,平均54岁。1.2临床表现病史最短1d,最长5年;4例患者均有头痛病史视力改变者例肢体面部麻木者例,2,、…     

颅内巨大动脉瘤载瘤动脉球囊闭塞及颅内外血管搭桥术

目的 探讨颅内巨大动脉瘤的治疗方法及疗效，并对球囊闭塞载瘤动脉近段以及联合颅内外血管搭术治疗方法进行评价。方法 对载瘤动脉球囊闭塞术治疗的21例巨大动脉瘤病人的资料进行分析。载瘤动脉闭塞试验(BOD阳性，首先行颅内外血管搭桥，再行血管球囊闭塞。结果 21例巨大动脉瘤病例中，单用球囊闭塞载瘤动脉17例，联合颅内外搭桥4例。术后随访17例，6个月动脉瘤内血栓形成，2例动脉瘤缩小；2例3年后动脉瘤消失，2例颈内外动脉搭桥术随访3～4年，血管造影示吻合口通畅。结论对直接手术和填塞难以治愈的颅内巨大动脉瘤，载瘤动脉球囊闭塞以及联合颅内外搭桥术是一种有效可取的方法。     

颅内巨大动脉瘤的血管内治疗分析

目的 探讨血管内治疗颅内巨大动脉瘤的安全性和有效性。方法 回顾性分析连续收治的74例颅内巨大动脉瘤患者的临床资料,其中采用血管内栓塞治疗57例,保守治疗17例。采用Logistic回归分析检验预后影响因素。结果 17例保守治疗患者随访4~71个月,平均（30.7±7.7）个月,死亡4例,症状加重6例、无变化6例、改善1例。57例血管内治疗患者中,术后即刻造影显示完全栓塞38例,次全栓塞6例,部分栓塞13例;28例影像随访3~63个月,平均（11.7±15.2）个月,复发10例（35.7%）;51例临床随访4~71个月,平均（30.7±17.7）个月,42例（73.7%）预后良好（改良Rankin量表评分0~1分）。年龄>60岁、动脉瘤位于后循环和保守治疗与不良预后显著相关（P<0.05）。>结论 对于年龄>60岁以及动脉瘤位于后循环的颅内巨大动脉瘤患者,治疗应慎重;血管内治疗颅内巨大动脉瘤复发率较高。     

血管移植搭桥治疗巨大动脉瘤

目的探讨中、高流量血管搭桥方法对颅内巨大颅内动脉瘤的治疗。方法8例巨大和颅底复杂动脉瘤患者,主要表现头痛发病者5例,视力减退者2例,面部麻木者1例。未破裂动脉瘤6例,2例患者发生动脉瘤破裂,Hunt-Hess分级分别为Ⅰ级和Ⅱ级。血管造影证实：动脉瘤体位于颈内动脉海绵窦段（C4段）4例、床突上段（C1段）2例、大脑中动脉M2～M1段者2例动脉瘤大小为2．5～6．0cm,平均直径3．7cm。其中6例动脉瘤为梭形,2例为宽颈动脉瘤。8例患者均采用额颞开颅,骨瓣要尽可能低到颅底,以缩短搭桥移植血管在颅外走行长度。通常用7-0显微缝线吻合移植血管与颈外动脉,用8-0缝线吻合移植血管与颅内段颈内动脉和大脑中动脉。4例患者利用大隐静脉移植搭桥,4例患者利用桡动脉移植搭桥。颅内、外搭桥完毕后将动脉瘤近心端和远端的供血动脉结扎和夹闭,阻断动脉瘤的全部血供。对3例有压迫脑神经或颅内占位引起颅压高的患者,将动脉瘤切除。结果5例术后头痛消失,1例视力减退者明显改善,1例动眼神经麻痹恢复。5例术后行脑血管造影检查,3例行CT血管造影检查,7例搭桥吻合血管全部畅通,动脉瘤消失。2例术后出现暂时性一侧肢体力弱,肌力在Ⅱ～Ⅲ级之间,术后1个月完全恢复。结论中、高流量颅内外血管搭桥可作为治疗颅内巨大动脉瘤的有效方法。     

血管内介入治疗颅内巨大动脉瘤23例报告

颅内巨大动脉瘤是指最大直径大于25 mm的动脉瘤,治疗仍十分困难,我们采用血管内介入治疗23例颅内巨大动脉瘤病人,并取得良好效果,现结合有关文献分析报告如下.     

颈内动脉巨大动脉瘤的血管内治疗

目的探讨血管内栓塞方法治疗颈内动脉巨大动脉瘤的效果和安全性。方法回顾性分析3例应用弹簧圈进行瘤腔内栓塞和27例应用载瘤动脉闭塞方法治疗的颈内动脉巨大动脉瘤的结果和随访资料。结果2例瘤腔内栓塞动脉瘤的患者症状完全消失;1例患者出现缺血性并发症,半年后随访动脉瘤再通。球囊闭塞载瘤动脉的患者1例出现迟发缺血性症状;1例吻合支开放,3个月后患者出血死亡;其余患者症状均有不同程度改善。结论颅内巨大动脉瘤是否进行瘤囊内弹簧圈栓塞需要综合考虑各种条件,采用个体化的治疗方案。球囊闭塞载瘤动脉是比较安全有效的方法。     

血管重建：颅内动脉瘤介入治疗新篇章

颅内动脉瘤现已成为导致成年人猝死的主要原因之一,常被形象比喻为颅内的“不定时炸弹”。传统的动脉瘤夹闭手术需要开颅、牵开脑组织进行动脉瘤夹闭,给正常脑组织带来了损伤。     

血管移植治疗颅内巨大蛇形动脉瘤一例及文献复习

Segal等于1977年首次提出了“巨大蛇形动脉瘤（giant serpentine aneurysm GSA）”这一概念，它构成颅内巨大动脉瘤的亚型，因其特殊的临床特征而不同于囊性和梭形动脉瘤。南方医院成功收治的1例右颈内动脉GSA，复习相关文献，就其诊断及血管搭桥治疗等方面作一讨论。     

闭塞载瘤动脉治疗颈内动脉巨大动脉瘤1例远期效果分析

1临床资料患者,女,54岁,头痛、头闷、视物模糊1月入院,视物模糊以右眼为主,有时有复视,眼球憋胀。既往无发热及外伤病史。体检：神志清楚,语言流利,双眼视野正常;视力：右0.5,左0.4,认知功能正常,四肢活动好,肌力5级,左侧巴宾斯基征阳性。头颅CT：右侧蝶骨棘内1/3处可见椭圆形略高密度影,大小28cm×36cm,CT值32～48Hu,边缘工整,     

颅内巨大动脉瘤的血管内治疗

目的探讨颅内巨大动脉瘤（GAs）血管内治疗的技术和疗效。方法回顾分析42例GAs血管内治疗病人的临床资料。结果29例载瘤动脉闭塞病人中,1例术后2月死于蛛网膜下腔出血,1例术后3个月出现脑缺血症状。9例弹簧圈栓塞和支架结合弹簧圈栓塞的病人,1例完全栓塞,8例有不同程度的弹簧圈移位。4例覆膜支架病人,1例术后6小时GAs再次破裂导致死亡,3例GAs闭塞。结论血管内治疗GAs是安全、有效的,首选载瘤动脉闭塞,弹簧圈部分栓塞能够减低动脉瘤破裂的风险,支架结合弹簧圈栓塞能够增加动脉瘤致密栓塞的可能,降低复发率,随着材料和工艺的发展优化,覆膜支架有希望成为最佳的治疗选择。     

Strategy for the treatment of inaccessible unruptured giant and large aneurysms of the internal carotid artery

Abstract

Our goal was to clarify the optimum management of the inaccessible unruptured giant and large aneurysms of the internal carotid artery (ICA). Since 1981, we have treated 18 patients with unclippable unruptured giant or large aneurysms of the ICA. Aneurysms were classified as either intracavernous or intradural. We performed proximal carotid occlusion in 12 patients and conservatively treated six patients. We retrospectively analyzed long-term outcomes in these patients. Four of seven patients with intradural aneurysm underwent proximal carotid occlusion, with good long-term outcomes. The three patients with intradural aneurysm, who were treated conservatively, died of subarachnoid hemorrhage. Eight of 11 patients with intracavernous aneurysm underwent proximal carotid occlusion, one dying of massive nasal bleeding 25 months after the procedure. In this case, the aneurysm was partially thrombosed, and residual lumen growth was revealed 22 months after proximal carotid occlusion. Cranial nerve paresis improved in five of the eight patients (63%), and two patients had a minor ischemic attack. Neurological problems failed to occur in the three patients with intracavernous aneurysm who were treated conservatively. The risk of rupture is relatively high in intradural giant and large aneurysms. Proximal carotid occlusion can effectively prevent bleeding from intradural aneurysms. Aggressive management is justified for intradural aneurysms with poor collateral circulation. Operative procedures in the management of an intracavernous aneurysm require careful consideration.     

颅内巨大动脉瘤血管内载瘤动脉闭塞治疗的临床研究

目的探讨可脱性球囊闭塞载瘤动脉治疗颅内巨大动脉瘤的技术要点与并发症的防治。方法对32例颅内巨大动脉瘤采用可脱性球囊行载瘤动脉闭塞术．其中29例第1枚球囊同时闭塞了动脉瘤口。栓塞效果根据术中DSA的影像表现分为优、良、中和差4级。术后影像随访采取DSA与，^99Tc^m-ECD SPECT脑血流灌注显像。计数资料采用χ^2检验。结果疗效优26例，良6例；术后死亡1例，病死率0．3％。全组术中并发脑缺血和脑梗死5例，及时发现经处理后恢复正常，术后并发脑缺血和脑梗死6例。术中及术后均无动脉瘤破裂出血。^99Tc^m-ECD SPECT脑血流灌注显像对载瘤动脉闭塞术后脑缺血诊断的灵敏度和准确性明显高于DSA，两者比较均具有显著性差异（P〈0．05）。结论可脱性球囊闭塞载瘤动脉治疗颅内巨大动脉瘤安全可靠，但该疗法有可能导致脑缺血及其他并发症．应严格掌握适应证：^99Tc^m-ECD SPECT脑血流灌注显像在术后随访中具有重要的应用价值。     

颅内蛇形动脉瘤的外科治疗（附21例报告）

目的 探讨蛇形动脉瘤的手术治疗方法。方法 21例蛇形动脉瘤中,14例未破裂动脉瘤,主要症状为头痛4例、可逆性脑缺血发作3例、颈项强直和后组脑神经压迫5例、视野缺损1例、癫痫发作1例;有动脉瘤破裂的7例中,Hunt - Hess Ⅰ级和Ⅱ级6例、Ⅲ级1例。病程从20d至3.5年,平均7.3个月。动脉瘤位于大脑中动脉M1段6例,M2段近端4例;大脑前动脉A1段1例,A.2段近端1例;大脑后动脉P1段2例;基底动脉主干2例,椎动脉5例。动脉瘤直径0.3 ～2.5 em,平均1.2 cm。13例动脉瘤长3.0 cm以上,8例动脉瘤长5.O cm以上。桡动脉移植搭桥7例,颞浅动脉搭桥6例,枕动脉搭桥6例,大隐静脉移植搭桥2例。12例为颅内外动脉搭桥,供血动脉为颈外动脉5例,枕动脉4例,颌内动脉3例。接受动脉为大脑中动脉5例,小脑后下动脉3例,大脑后动脉P2段3例,小脑前下动脉1例。9例为动脉瘤近端与远端间的血管间插入移植搭桥,包括大脑中动脉M1与M2段间的插入移植搭桥3例,M1段间的搭桥2例,大脑前动脉A1远端与A2近端插入搭桥2例,椎动脉颅内与颅外端间搭桥2例。在搭桥外血管完毕后,11例行动脉瘤孤立术;7例行动脉瘤切除;3例仅将动脉瘤近心端阻断,保护穿通动脉开通,避免缺血发生。结果 20例术后恢复良好,包括头痛缓解,癫痫局部发作或大发作消失,肢体活动障碍的改善和视力的恢复。1例出院时需要照顾。术后脑血管造影检查,19例移植搭桥血管畅通,动脉瘤消失;1例吻合血管未通,但无神经功能缺失表现;1例颅内外搭桥后,术后第2天手术部位出现血肿,手术清除血肿,术后肢体肌力Ⅳ级。结论 对于单纯手术无法夹闭的蛇形动脉瘤,通过适当血管搭桥或插入性移植的方法可得到满意的效果。     

海绵窦及床突旁大型和巨大型动脉瘤的手术治疗

目的 探讨海绵窦和床突旁大型、巨大型动脉瘤的特点、手术适应证及手术方法.方法 1998至2006年对36例床突旁和海绵窦大型、巨大型动脉瘤经外科于术治疗.常规采取翼点入路,暴露颈部颈内动脉.分别采用动脉瘤直接夹闭,动脉壁修补及动脉瘤孤立加颅内外血管搭桥等方式处理动脉瘤.术中使用脑电图(EEG)及体感诱发电位(SEP),以及多普勒(Doppler)、内镜等辅助设备.结果 32例床突旁动脉瘤直接夹闭,1例海绵窦内假性动脉瘤行载瘤动脉修补术,3例海绵窦动脉瘤行孤立加颅内外血管搭桥术.出院时GOS评分良好者32例(89%),重残2例(5.6%),死亡2例(5.6%).结论 不适宜栓塞治疗的海绵窦动脉瘤应采取手术治疗,而床突旁动脉瘤则首选手术治疗.     

颅内-外血管搭桥加孤立术治疗大脑中动脉复杂动脉瘤

目的探讨颅内-外血管搭桥加动脉瘤孤立术在大脑中动脉复杂动脉瘤治疗中的方法和效果。方法对6例大脑中动脉复杂动脉瘤患者采用颅内-外血管搭桥加动脉瘤孤立手术。术后复查脑血管造影和(或)超声评价搭桥是否通畅,并就相关临床资料进行分析。结果颞浅动脉-大脑中动脉搭桥4例中,吻合口通畅4例,运动性语言障碍加重1例。颈外动脉-大隐静脉移植-大脑中动脉搭桥2例,搭桥血管不通畅1例。随访2-17个月,恢复良好5例,生活自理1例。结论颅内-外血管搭桥加动脉瘤孤立术是治疗大脑中动脉复杂动脉瘤的可行方法。     

Reported incidence and treatment modalities of giant cerebral aneurysms in the pediatric population: A systematic review and illustrative case report

Giant intracranial aneurysms represent a complex pathology that pose challenges for management, especially in the pediatric population. With emerging endovascular techniques, combined endovascular and open surgical approaches may be a favorable alternative for complex cases. In this systematic review, we characterize the treatment modalities of giant aneurysms in the pediatric population and provide an update on the number of giant aneurysms reported in the literature by anatomic location. We conducted a literature search of PubMed, Embase, and Medline databases with the following terms: ‘pediatric’ AND ‘giant’ AND ‘intracranial aneurysm.’ Studies were included if data on treatment modality and aneurysm location were available for pediatric patients with giant intracranial aneurysms. The literature search yielded a total of 188 papers, with 82 pediatric patients from 33 articles ultimately meeting inclusion criteria. There were significantly more male than female patients (p = 0.011), with 52 and 29 respectively. Patients presenting with a ruptured aneurysm were significantly younger than patients presenting without rupture (p = 0.018), with a median age of 8.0 and 12.0 years, respectively. There were 45 giant aneurysms reported in the anterior circulation and 37 in the posterior circulation. Anterior aneurysms were most often treated with surgical approaches, while posterior aneurysms were typically treated with endovascular interventions (p = 0.002). Although combined surgical and endovascular approaches were the least frequently utilized, we suggest a combined approach may be particularly useful for patients with complex cases that require a management plan tailored to their needs.     

高分辨磁共振血管壁成像在评估颅内动脉瘤中的初步应用

目的探讨高分辨磁共振血管壁成像(high-resolusion magnetic resonance vessel wall imaging,HR-VWI)评估颅内动脉瘤的可行性。方法根据动脉瘤是否破裂,将接受HR-VWI检查的颅内动脉瘤分为破裂组(n=12)和未破裂组(n=88),对比两组动脉瘤的部位、大小、瘤颈宽度、高/颈比(aspect ratio,AR)、子囊和瘤壁强化等级。以动脉瘤是否破裂为因变量,以上各因素为自变量进行单因素和多因素Logistic回归分析。未破裂动脉瘤中,对症状性亚组(n=8)和无症状亚组(n=80)进行对比分析。结果破裂组的动脉瘤大小(t=2.187,P=0.031)、AR(t=3.164,P=0.002)、子囊比例(P=0.012)和瘤壁强化分级(P0.001)大于未破裂组。多因素Logistic回归提示瘤壁强化等级是破裂动脉瘤的独立危险因素(P=0.002)。未破裂动脉瘤中,症状性亚组瘤壁强化分级(P0.001)和AR(t=3.939,P0.001)大于无症状亚组。结论破裂动脉瘤中HR-VWI瘤壁强化分级高于未破裂动脉瘤,症状性未破裂动脉瘤存在瘤壁强化现象。有必要获得瘤壁的组织学标本,与HR-VWI结果对照分析,进一步研究瘤壁强化的机制和意义。