颅内多发动脉瘤的治疗

目的探讨颅内多发动脉瘤的诊断、手术时机和治疗方法。方法 48例颅内多发动脉瘤患者共有105个动脉瘤,均进行了3D-CTA或/和脑DSA检查,41例患者采用开颅手术或/和血管内栓塞治疗,7例患者放弃治疗。一次性手术一侧开颅29例,一次性手术双侧开颅1例,分次手术4例,一次性血管内栓塞4例,开颅手术+血管内栓塞3例。结果 41例患者共成功夹闭或血管内栓塞治疗91个动脉瘤,其中39例随访3月~5年,无再出血症状发生,1例开颅夹闭加包裹术的患者出院后4年包裹的动脉瘤再次破裂出血死亡,1例夹闭一侧动脉瘤的患者出院后2年对侧动脉瘤破裂出血,再次入院手术治疗后康复。39例患者随访时进行GOS评分,5分30例,4分4例,3分3例,2分1例,1分1例。35例患者经3D-CTA或/和DSA复查,未见动脉瘤新生或再通。7例放弃治疗的患者随访3月~2年,未破裂的动脉瘤患者4例,其中2例发生破裂出血死亡,破裂的动脉瘤患者3例均发生再次破裂出血死亡。结论 CT、3D-CTA的应用能为颅内多发动脉瘤的诊断及术后复查提供有效的帮助,DSA仍是颅内多发动脉瘤诊断的金标准,对颅内多发动脉瘤的患者应尽早采取开颅手术或血管内栓塞治疗,能有效改善预后。

Treatment of multiple intracranial aneurysms by neurosurgery and endovascular embolization

Objective To investigate the diagnosis, surgical opportunity and therapeutic method of the multiple intracranial aneurysms. Methods DSA or 3D-CTA were performed before the operation in 48 patients with 105 intracranial aneurysms. Of 48 patients with intracranial aneurysms, 41 were treated by craniotomy and/or endovascular embolization, and 7 gave up treatment. Of 41 patients with multiple intracranial aneurysms receiving the treatment, 29 underwent only one unilateral craniotomy, 1 did only one bilateral craniotomy, 4 did two craniotomies, 4 did endovascular embolization and 3 did craniotomy and endovascular embolization. Results Ninety-one aneurysms were successfully clipped or embolized in 41 patients. Of 41 patients followed up from 3 to 5 years, 39 did not suffered from intracranial rebleeding and 2 did due to the rupture of the aneurysms 2 and 4 years respectively after the operation. Conclusions 3D-CTA is helpful to the diagnosis and postoperative reexamination of the multiple intracranial aneurysms. The cerebral angiography is still the gold standard of the diagnosis of the multiple intracranial aneurysms. The multiple intracranial aneurysms should treated as early as possible in order to improve the prognosis of the patients.