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1.
显微手术和介入治疗急性期颅内动脉瘤破裂的对比性研究   总被引:12,自引:6,他引:6  
目的 比较显微外科手术和血管内介入治疗急性期颅内动脉瘤破裂的疗效和相关并发症。方法 82例破裂性颅内动脉瘤,均在蛛网膜下腔出血急性期(72h以内)行外科治疗,其中行显微手术瘤颈夹闭40例,血管内电解可脱性弹簧圈栓塞治疗42例。对两组疗效和并发症进行对比分析。结果 显微手术组,完全夹闭率92.5%,手术相关并发症4例,死亡2例。弹簧圈栓塞组,完全闭塞率71.4%,栓塞组相关并发症6例,死亡1例。在前循环动脉瘤中,栓塞组完全闭塞率与手术组完全夹闭率相比较,显微手术组结果优于栓塞组。临床随访6个月,两者预后良好者均达95.0%。结论 显微瘤颈夹闭术和血管内栓寒治疗均是颅内动脉瘤治疗的有效方法。  相似文献   

2.
显微手术夹闭与血管内栓塞是颅内动脉瘤治疗的常用方法~([1]).但对治疗方案的选择、治疗时机的把握与疗效评价仍有较大争议~([2-3]).我们总结了经显微手术夹闭和血管内介入栓塞治疗的160例破裂颅内动脉瘤,取得了满意疗效.  相似文献   

3.
目的:总结颅内动脉瘤显微外科手术治疗的经验。方法:对49例颅内动脉瘤进行显微手术治疗,其中46例行直视手术夹闭,2例行动脉瘤孤立术,1例行动脉瘤包裹术。结果:术后恢复良好39例,轻残7例,重残1例,死亡2例。结论:显微手术夹闭术是颅内动脉瘤的主要治疗方法,选择合适的手术时机是成功的关键。  相似文献   

4.
目的 探讨颅内动脉瘤破裂早期血管内栓塞与显微手术的效果。方法  160例颅内动脉瘤破裂在 3d内早期经血管内栓塞和显微手术得到治疗 ,其中 114例经血管内栓塞 ,46例显微手术。结果  114例血管内治疗 ,78例完全闭塞 ,2 1例闭塞 95 % ,10例闭塞 90 % ,5例闭塞 85 %。出院时优 83例 ,良 19例 ,差 1例 ,死亡 11例。显微手术 46例 ,术后 2周行DSA检查证实动脉瘤全部夹闭。出院时 ,优 2 4例 ,良 10例 ,差 4例 ,植物生存 2例 ,死亡 6例。结论 颅内动脉瘤早期治疗 ,是杜绝再次出血的危险 ,有利于脑血管痉挛的防治 ,降低致残率和死亡率。  相似文献   

5.
目的 探讨未破裂颅内动脉瘤的处理方式及其疗效,以指导临床治疗.方法 回顾性分析我科收治的72例未破裂颅内动脉瘤的患者,所有患者均行DSA或CTA明确诊断,采用血管内栓塞治疗、开颅手术夹闭或者观察三种治疗策略,对比分析其疗效.结果 血管内栓塞治疗15例,手术夹闭40例.出院时GOS评分5分血管内介入治疗组14例(93.3%),开颅手术夹闭组31例(77.5%).两组患者治疗后出院前行GOS评分经卡方检验无明显差异(P>0.05).观察随诊处理17例,无变化15例,再出血2例.结论 根据未破裂动脉瘤的特点、患者自身状况及要求、就诊中心诊疗技术等决定未破裂动脉瘤的治疗方式,个体化治疗是最佳的治疗方案.  相似文献   

6.
目的 总结创伤性胼胝体血肿与创伤性胼周动脉动脉瘤关系及其诊断及治疗方式.方法 对15例创伤性胼周动脉瘤患者进行手术治疗,其中6例经纵裂入路开颅行创伤性胼周动脉瘤夹闭术,9例行血管内栓塞治疗.结果 9例治愈,无神经功能缺失,5例有永久性神经功能缺失,1例死亡.结论 创伤性胼胝体血肿提示创伤性胼周动脉瘤,血管内栓塞及显微手术夹闭治疗创伤性胼周动脉瘤,其效果均较好,但血管内栓塞仍是主要的外科治疗方法.  相似文献   

7.
颅内动脉瘤的外科治疗有两种主要方法:第一是经血管内栓塞动脉瘤腔。血管壁修复治疗;第二种方法是传统的开颅直视下瘤颈夹闭或姑息加固手术。外科治疗的主要目的包括:①将动脉瘤从脑循环中隔离出去,消除出血或再出血隐患。②消除或改善局部占位,缓解局部压迫。③要最大限度地保留载瘤动脉通畅。但不管采用哪种方法,颅内动脉瘤的治疗应遵循最快捷、有效的治疗措施,最小的医疗干预,使患者获得最大受益的原则。  相似文献   

8.
Hunt-HessⅣ级颅内动脉瘤的早期血管内治疗   总被引:2,自引:0,他引:2  
目的 探讨早期血管内栓塞颅内Hunt-Hess分级Ⅳ级动脉瘤的临床疗效及应用价值。方法 回顾性分析早期血管内栓塞治疗颅内动脉瘤16例16个颅内动脉瘤。结果 16例完全栓塞11例,大部分栓塞5例,1例死亡,并发动脉瘤破裂2例、脑血管痉挛3例、脑梗死2例、4例再次栓塞后痊愈。结论 早期血管内栓塞是治疗颅内Hunt-Hess分级Ⅳ级动脉瘤较理想方法。  相似文献   

9.
颅内动脉瘤破裂所致的蛛网膜下腔出血(subarachnoid hemorrhage.SAH)是较为常见的急性脑血管意外,本院2004年9月至2008年12月手术夹闭治疗动脉瘤26例。同时血管内栓塞治疗颅内动脉瘤27例,现报道如下。  相似文献   

10.
平板3D-DSA在颅内动脉瘤诊断和介入治疗中的价值   总被引:2,自引:1,他引:1  
目的评估平板探测器三维数字减影血管造影(3D-DSA)技术在颅内动脉瘤诊断和介入治疗中的应用价值。方法对51例蛛网膜下腔出血的患者进行常规全脑血管DSA检查后,再行旋转DSA采集数据,利用工作站进行三维重建。分析3D-DSA与常规DSA对颅内动脉瘤显示的差异,评价3D-DSA对介入栓塞治疗的指导意义。结果常规DSA检出脑动脉瘤34例,经应用旋转DSA及三维重建后检出46例,其中35例进行介入血管内栓塞治疗,栓塞效果良好,11例行手术夹闭治疗。结论3D-DSA可显著提高颅内动脉瘤的检出率,能够直观清楚地显示动脉瘤详细全面的解剖信息,指导制定治疗计划,在脑动脉瘤的诊断和介入治疗中具有重要的价值。  相似文献   

11.
Wong GK  Yu SC  Poon WS 《Surgical neurology》2007,67(2):122-6; discussion 126
BACKGROUND: Aneurysm recurrence is an innate problem in endovascular treatment of aneurysms with coils. A coated coil system named Matrix (Boston Scientific Neurovascular, Fremont, CA), covered with a bioabsorbable polymeric material (polyglycolide/lactide copolymer [PGLA]), was developed to accelerate intraaneurysmal clot organization and fibrosis. The purpose of this study was to evaluate the efficacy and safety of the Matrix detachable coils in patients with intracranial aneurysms and aneurysmal recurrence rate. METHODS: In a regional neurosurgical center in Hong Kong, data of patients undergoing endovascular embolization of intracranial aneurysm was collected. In a 20-month period, 42 patients with 44 aneurysms were treated by endovascular embolization using matrix coils alone or mixed with bare platinum coils. Thirty-four patients presented with ruptured aneurysms, and 8 patients presented with unruptured aneurysms. RESULTS: Twenty-five patients (60%) had 6-month follow-up DSA, and 10 patients (24%) had 18-month follow-up DSA. Seven aneurysm recurrences were identified, amounting to 16% for all aneurysms and 14% for ruptured aneurysms. Four patients were treated by repeated embolization, and 2 patients were treated by microsurgical clipping. Two adverse events due to thromboembolism were noted. One 78-year-old lady with poor-grade subarachnoid hemorrhage treated by partial embolization died from rebleed at day 4. Another patient with partial embolization and spontaneous thrombosis of dorsal wall ICA aneurysm died at 2 months with aneurysm recanalization with rerupture. Twenty-six patients achieved favorable outcome (GOS score 4 or 5) at last follow-up. The aneurysm recurrence rate using bare platinum coils of the same center was 11% and 7% for all aneurysms and ruptured aneurysms, respectively. CONCLUSION: Matrix coil embolization was safe, but there was no reduction in aneurysm recurrence using matrix coils alone or mixed with GDCs, compared with GDCs alone.  相似文献   

12.
BACKGROUND: Endovascular embolization of cerebral aneurysms has evolved rapidly worldwide within the last years, and has gained more popularity at the expense of surgical clipping; however, both regimens have inherent risks. This study was undertaken to asses the cerebral complications associated with both modalities of cerebral aneurysm treatment. METHODS: We retrospectively reviewed the charts, operative and embolization reports, and imaging of patients who underwent surgical clipping or embolization for cerebral aneurysms at our institution between October 2001 and October 2004. Patients were divided into 2 groups: group A, patients who had confirmed subarachnoid hemorrhage; group B, patients with unruptured cerebral aneurysms. Patients belonging to group A were evaluated according to the Hunt and Hess scale with their computed tomography scan evaluated according to Fisher scale. Short-term outcome was measured with Glasgow Outcome Scale for both groups. RESULTS: One hundred thirty-three patients with 168 aneurysms were treated; 95 (71.4%) were women and 38 (28.6%) men; mean age was 60.28 years. Hypertension (29.6%) was the most commonly encountered risk factor; average size of aneurysms treated was 7.21 mm; 53 patients belonged to group A. Seven patients were Hunt and Hess grade I, 23 grade II, 11 grade III, 7 grade IV, and 5 grade V. Eighty patients belonged to group B; for both groups, the periprocedural technical complication rate associated with coiling was 8.4% vs 19.35% with clipping. Follow-up angiographic results were better with clipping, as total aneurysm occlusion was 81.4% vs 57.5% with coiling. In group A, the incidence of angiographic vasospasm was 17.4% vs 45.4% with coiling vs clipping, whereas the incidence of shunt-dependant hydrocephalus was comparable with embolization and clipping. In group A, excellent outcome was achieved in 62% vs 44% (endovascular vs surgical) of subgroups, whereas in group B, it was 93% vs 81%, respectively. CONCLUSION: With rapidly evolving technology of endovascular embolization, accumulated experience, and good selection of patients with optimum angioanatomical criteria and endovascular accessibility, our results of morbidity and mortality associated with both modalities of cerebral aneurysm treatment with short-term outcome show that endovascular embolization of cerebral aneurysms is a safe alternative to surgical clipping in the treatment of both ruptured and unruptured cerebral aneurysms; however, long-term outcome needs to be evaluated.  相似文献   

13.
Paraclinoid aneurysms represent a significant surgical challenge. Multiple techniques have been developed to maximize the effectiveness and safety of excluding these aneurysms from the cerebral circulation. Endovascular balloons have been used for proximal control of parent arteries during the treatment of aneurysms. In this report the authors describe the technique of navigating an endovascular balloon across the neck of paraclinoid aneurysms in four patients to gain proximal control, improve the accuracy of clip placement, and reduce the risk of distal embolization of intraluminal thrombus. Six consecutive patients with giant or complex aneurysms of the ophthalmic or paraclinoid internal carotid artery that were not amenable to endovascular obliteration were retrospectively analyzed. In all six patients, the aneurysm was exposed and dissected for microsurgical clipping, and attempts were made to navigate a nondetachable, compliant silicone balloon across the neck of the aneurysm. If successfully placed, the balloon was inflated during clip placement. In four patients, the balloon was successfully navigated across the neck of the aneurysm and was inflated during clip application. Internal carotid artery tortuosity precluded navigation of the balloon into the intracranial circulation in two patients. All aneurysms were completely excluded from the parent vessel according to postoperative angiography studies. No complication occurred as a direct result of the endovascular portion of the procedure. Endovascular balloon stenting of complex paraclinoid aneurysms during microvascular clipping may provide an adjunctive therapy that facilitates safe and accurate clip placement.  相似文献   

14.
The International Subarachnoid Aneurysm Trial has shown that coil embolization achieves a better outcome for aneurysms treatable by either clipping or coil embolization. However, many ruptured aneurysms are hardly treatable by either clipping or coil embolization. Selection of either clipping or coil embolization will affect the treatment outcome for ruptured aneurysms. The relationship between patient selection and treatment outcome in a so-called "regional center hospital" in Japan must be clarified. This study included 113 patients with ruptured intracranial saccular aneurysms measuring less than 10 mm. Selection criteria for coil embolization were principally paraclinoid or posterior circulation aneurysm, Hunt and Hess grade IV or over, and patient age 75 years or older. Other aneurysms were principally treated by clipping. Aneurysms with a dome/neck ratio of less than 1.5, distorted aneurysms, Hunt and Hess grades I-III, patient age 74 years or younger, and middle cerebral artery aneurysm were actively treated by clipping. A few exceptional indications were considered in detail. Low invasiveness coil embolization is better than clipping to obtain good neurological outcome for patients with perforators difficult to dissect, aneurysms difficult to dissect due to previous open surgery, and aneurysms requiring bilateral open surgery, despite the slightly higher rebleeding rate in coil embolization. Overall outcomes were modified Rankin Scale (mRS) 0-2 in 82 of 113 patients (73%) and mRS 3-6 in 31 (27%). Appropriate selection of clipping or coil embolization can achieve acceptable treatment outcomes for ruptured aneurysm.  相似文献   

15.
OBJECT: The purpose of this paper is to present the authors' experience with Guglielmi detachable coil (GDC) embolization of multiple intracranial aneurysms and to evaluate the results of this therapy in single-stage procedures. METHODS: Clinical and angiographic evaluations were performed in 38 consecutive patients with multiple intracranial aneurysms treated by GDC embolization between March 1990 and October 1997. Twenty-nine patients presented with subarachnoid hemorrhage (SAH), four with mass effect, and five were asymptomatic. These 38 patients harbored 101 aneurysms, 79 of which were treated with GDCs, 14 by surgical clipping, and eight were left untreated. Of the GDC-treated lesions, a complete endovascular occlusion was achieved in 55 aneurysms (70%), and 24 (30%) presented neck remnants. Twenty-five patients (66%) underwent GDC embolization of more than one aneurysm in the first session. Eighteen (86%) of 21 patients with acute SAH underwent treatment for all aneurysms within 3 days after admission (15 of 21 in one session). Follow-up angiographic studies in 30 patients demonstrated an unchanged or improved result in 94% of the aneurysms (59 lesions) and coil compaction in 6% (four lesions). The overall clinical outcome was excellent in 34 patients (89%), good in one (3%), fair in one (3%), and death in two (5%). CONCLUSIONS: Endovascular treatment of multiple intracranial aneurysms, regardless of their location, with GDCs was performed safely in one session, even during the acute phase of SAH. Treatment of all aneurysms in one session protected the patient from rebleeding and eliminated the risk of mistakenly treating only the unruptured aneurysms.  相似文献   

16.
In Europe only few neurosurgeons are trained in both open surgical clipping as well as in endovascular techniques for treatment of intracranial aneurysms. To investigate the safety and efficacy of performing both techniques we, two dual trained neurosurgeons, analyzed our results in repairing ruptured intracranial aneurysms. Prospectively collected data from 356 patients that underwent open surgical or endovascular repair of a ruptured intracranial aneurysm at the Neurosurgical Centre Nijmegen from 2006 to 2012 by two dual trained neurosurgeons were retrospectively analyzed. Complication rates, occlusion rates, and retreatment rates were obtained. Combined procedural persistent neurological morbidity and mortality after endovascular treatment and open surgical clipping were 2.1 % and 1.4 %, respectively. Overall procedure-related clinical complication rate for endovascular treatment was 5.9 % in 285 procedures for 295 aneurysms. Overall procedure-related clinical complication rate for open treatment was 9.9 % in 71 procedures for 72 aneurysms. Follow-up was available for 255 out of 295 coiled aneurysms, 48 aneurysms recurred and 34 needed retreatment. For clipping 54 out of 72 treated aneurysms had follow-up; four aneurysms were incompletely clipped. One aneurysm was retreated. Treatment of ruptured intracranial aneurysms by neurosurgeons that perform both open surgical clipping as well as endovascular techniques is safe and effective. Developing training programs in Europe for hybrid neurosurgeons that can provide comprehensive patient care should be considered.  相似文献   

17.
BACKGROUND: Intracranial mycotic aneurysms, although rare neurovascular pathology, represented a neurosurgical challenge that required careful stepwise decision making. Different approaches for their management were used. We present our experience with 4 patients treated in terms of indications and efficacy of different treatment modalities. METHODS: Four patients with infective endocarditis and 5 intracranial mycotic aneurysms were treated during the last 5 years. All of the patients were men; their ages ranged between 29 and 62 years (mean, 47.3 years). Distal MCA was the commonest site (3 patients) of aneurysm, 1 was located at the distal PCA, whereas the remaining aneurysm was at the distal ACA. Angiographic studies were done in 2 patients because of neurologic signs and for screening in 2 patients with documented endocarditis. RESULTS: One patient was treated conservatively because of his moribund general condition; 1 patient was treated with direct surgical clipping; 1 patient was treated with surgical trapping and resection of the aneurysm without revascularization; and the remaining patient, harboring 2 distal mycotic aneurysms, was treated with selective embolization for his PCA aneurysm and endovascular trapping for the distal ACA aneurysm. Follow-up angiographic results showed stable occlusion of the aneurysms. No periprocedural technical complications were reported, and none of the patients, including the patient with medical treatment only, has ever experienced new neurologic events after definitive treatment. CONCLUSIONS: Prolonged courses of antibiotics are recommended for all patients with mycotic aneurysms. Selective endovascular embolization or trapping with soft and ultrasoft electrolytically detachable coils seems to be an effective technique that should be considered for treatment of dynamic unruptured mycotic aneurysms, with conventional surgical repair restricted for ruptured aneurysms with associated hematoma and high intracranial pressure.  相似文献   

18.
We discussed management strategies for unruptured aneurysms by an analysis of 62 treated and 48 untreated cases. The treated cases were divided into the following two groups; Group A consisted of 38 patients with 46 aneurysms treated during our initial 13 years (7 males, 31 females, 54 +/- 9 years old), and Group B of 24 patients with 32 aneurysms (8 males, females 16, 57 +/- 9 years old) during the last 3 years. In Group A, 36 patients were treated with neck clipping, except for two patients, who had giant aneurysms treated with internal carotid ligation and bypass surgery. All the patients in Group B were treated with either clipping or endovascular coil embolization. Our indications for coil embolization include patients with aneurysms located in paraclinoid internal carotid or basilar arteries, or with multiple aneurysms requiring more than one operation, or with a systemic risky disease for general anesthesia. In group A, 2.6% of cases resulted in death during operation and 10.3% of cases resulted in morbidity, while in group B, there was neither mortality nor morbidity caused by clipping, except for a patient with mild hemiparesis who had been treated with clipping for SAH caused by a procedure of coil embolization. The 50 aneurysms of 48 untreated patients have been observed without any neurosurgical treatment during periods of 6 months to 10 years with a mean of 2 years 7 months. Eventually, four aneurysms resulted in SAH, which cases were treated with emergency clipping or coil embolization. The high rupture rate (3.1% per year) in the natural history may suggest that some aneurysms are more likely to rupture than generally considered. We also reviewed operative findings of all entry clipping cases; more than 80 percent of aneurysms, including those measuring less than 5 mm in diameter, had red colored, thin wall domes with or without bleb. Our conclusion is that surgical indications are for a complementary use of clipping and coil embolization.  相似文献   

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