电解可脱卸弹簧圈栓塞颅内动脉瘤93例

目的：总结电解可脱卸弹簧圈（ＧＤＣ）栓塞治疗颅内动脉瘤的临床经验。方法：９３例颅内动脉瘤（共１１８个）患者中８４例为破裂动脉瘤，按Ｈｕｎｔ－Ｈｅｓｓ分级：Ⅰ级１８例，Ⅱ级２９例，Ⅲ级２５例，Ⅳ级１０例，Ⅴ级２例。８０例行急诊栓塞，术后腰椎蛛网膜下腔持续引流，并予以３Ｈ治疗。结果：动脉瘤完全闭塞１０４个（８８．１４％），闭塞达９０％以上１１个（９．３２％），闭塞在９０％以下３个（２．５４％）。全组手术死亡３例（３．２３％）。随访２～２２个月，１例术后２周死于中枢衰竭及肺部感染；１例术后１．５个月复发出血，经手术夹闭痊愈；２例术后复查发现瘤颈扩大，经再次填塞后痊愈；１例（１．０７％）重残，７例（７．５３％）有轻度神经功能缺失症状，其余恢复良好。结论：ＧＤＣ栓塞颅内动脉瘤安全、可靠，可致密填塞动脉瘤疗效为佳；破裂动脉

Embolization of intracranial aneurysm by Guglielmi detachable coils in 93 patients

Objective:To retrospectively study embolization by Guglielmidetachable coil (GDCs) in 93 patients with 118 intracranial aneurysms and to access its indication,technical tip,prevention and treatment of complications.Methods:From July 1998 to February 2000,93 patients with intracranial aneurysms (Hunt-Hess grade,I 18 cases,Ⅱ 29 cases,Ⅲ 25 cases,Ⅳ 10 cases,Ⅴ 2 cases)were embolized using GDCs,including 84 ruptured aneurysms. Eighty patients were treated with emergency.Continuous lumbar subarachnoid drainage was instituted and standard three-H treatment was given postopertively.Results:Total occlusion was achieved in 104 aneurysms(88.14%),over 90% in 11 aneurysms (9.32%),less than 90% in 3 aneurysms (2.54 %),with 3 patients (3/93,3.23%) died in the cohort.One case rebleeded after one and a half months and was cured by surgical clipping,2 patients experienced enlargement of the aneurysmal neck and were reembolized.One had se vere disability,7 had mild neurological deficit.Conclusion:Embolization of intracranial aneurysms with GDCs is safe,effective and reliable.Partial packing may result in continuous enlargement,rupture and bleeding,while tight coil packing is reliable.The ruptured aneurysms need emergent embolization and continuous lumbar subarachnoid drainage postoperatively can enhance curative effect significantly.