单一治疗方法未完全治愈颅内动脉瘤的再处理

目的探讨单一治疗方法(开颅夹闭或血管内栓塞)不能完全治愈颅内动脉瘤的再处理。方法回顾性分析采用开颅夹闭或血管内栓塞治疗的13例颅内动脉瘤患者的临床资料,包括影像学结果、治疗方法和疗效。结果13例患者中,4例初次治疗选用开颅夹闭,9例初次治疗选用血管内栓塞。共患有动脉瘤18个,其中大脑中动脉分叉部动脉瘤3个,前交通动脉动脉瘤8个,后交通动脉动脉瘤4个,胼周动脉瘤2个,基底动脉尖端动脉瘤1个。13例中4例有多发动脉瘤。血管内栓塞后,7例复发或残余动脉瘤行再次开颅夹闭术;手术夹闭联合血管内栓塞处理颅内多发动脉瘤3例;开颅夹闭后残余动脉瘤3例行血管内栓塞治疗。所有患者均治愈出院,临床随访1个月至3年,患者临床症状无复发表现。结论开颅夹闭联合血管内栓塞治疗初次处理复发、残余动脉瘤以及颅内多发动脉瘤是安全、有效的治疗方法。

Retreatment of incompletely obliterated intracranial aneurysm after surgical clipping or intra-arterial embolization

Objective To investigate the efficacy and strategy of retreatment for incompletely obliterated intracranial aneurysm treated with surgical clipping or endovascular embolization before.Methods The clinical data of 13 patients with intracranial aneurysm treated with surgical clipping or endovascular embolization were analyzed retrospectively.Results Of the 13 patients,4 patients underwent surgical clipping and 9 patients underwent endovascular embolization as the initial treatment.There were 18 aneurysms in 13 patients,including 3 middle cerebral artery bifurcation aneurysms,8 anterior communicating aneurysms,4 posterior communicating aneurysms,2 pericallosal aneurysms,and 1 aneurysm at the top of the basilar artery.Four patients had multiple aneurysms.Surgical clipping was performed in 7 patients with recurrent and residual aneurysms after endovascular embolization;3 patients with multiple intracranial aneurysms were treated with the combination of surgical clipping and endovascular embolization;endovascular embolization was performed in 3 patients with residual aneurysms after surgical clipping.All patients were cured and discharged.The clinical follow-up ranged from 1 month to 3 years,and no recurrent clinical symptoms were observed.Conclusion Surgical clipping in combination with endovascular embolization is a safe and effective therapeutic method for treatment of recurrent,residual and multiple intracranial aneurysms.