破裂颅内动脉瘤的血管内治疗

目的分析总结破裂的颅内动脉瘤血管内治疗的效果及特点。方法24例患者术前头部CT或MRI检查均为自发性蛛网膜下腔出血，DSA检查确诊为颅内动脉瘤，共28个，其中1例患者有3个动脉瘤，2例患者各有2个动脉瘤。动脉瘤直径2～5mm10个，6-15mm16个，16～25mm2个。Hunt～Hess分级Ⅰ级5例，Ⅱ级8例，Ⅲ级8例，Ⅳ级2例，Ⅴ级1例。24例动脉瘤均采用血管内栓塞治疗，其中1例患者的3个动脉瘤栓塞了2个，另1个行手术夹闭。结果临床治愈21例，偏瘫1例，死亡2例。术后随访3-24个月，存活22例均恢复良好，无再出血发生。结论血管内栓塞治疗颅内动脉瘤效果满意，并发症少，残死率低。     

颅内破裂动脉瘤手术时机的临床研究

目的 探讨颅内破裂动脉瘤不同手术时机患者的血清炎性因子水平变化及其临床意义。方法 回顾性分析2017年6月-2019年12月在本院神经外科确诊的颅内动脉瘤性蛛网膜下腔出血患者180例,根据医师建议和患者自愿分为早期治疗组(入院1～3 d进行手术治疗)和延期治疗组(入院4～14 d进行手术治疗),比较2组患者手术前后血清炎性细胞因子水平变化,并对2组患者的疗效和术后并发症发生情况进行比较。结果 手术前2组血清TNF-α,IL-6,IL-1β水平无显著差异(P>0.05); 2组术后第8 d血清TNF-α,IL-6,IL-1β水平均较术前有所降低(P<0.05); 早期治疗组术后第8 d血清TNF-α,IL-6,IL-1β水平显著低于延期治疗组(P<0.05)。早期治疗组的总有效率显著高于延期治疗组(P<0.05); 早期治疗组的恢复良好率显著高于延期治疗组(P<0.05); 早期治疗组的致残率显著低于延期治疗组(P<0.05)。2组重残率、植物生存率及病死率无显著差异(P>0.05)。早期治疗组的颅内感染和脑血管痉挛的发生率明显低于延期治疗组(P<0.05),脑积水和再出血的发生率没有显著差异(P>0.05)。结论 早期治疗的颅内破裂动脉瘤患者的术后血清炎性指标水平变化较显著,疗效及预后均较好,并发症发生率低; 血清炎性指标水平可能与患者的疗效和预后有关,可作为aSAH发生发展的预测指标。     

颅内动脉瘤破裂中期的血管内治疗

目的 探讨颅内动脉瘤破裂中期(4-10d)血管内栓塞治疗的安全性、技术要点及疗效.方法 根据在DSA影像上有无脑血管痉挛(CVS)将全组48例患者分为两组:A组26例为有CVS者,B组22例为无CVS者.全组均在蛛网膜下腔出血(SAH)后4-10d采用可脱性微弹簧圈对破裂性颅内动脉瘤行囊内栓塞.患者均在治疗后3个月时行Glasgow预后评分(COS),治疗结果经,检验.结果 全组动脉瘤腔100%闭塞42例,95%闭塞者4例,90%闭塞者2例;其中100%闭塞的患者中A组22例,B组20例,两组完全栓塞率比较差别无统计学意义(χ<'2>=0.43,P>0.05).术中出现与栓塞技术相关的并发症3例.A组GoS:ⅠI级10例,Ⅱ级5例,Ⅲ级7例,Ⅳ级1例,Ⅴ级3例;B组COS:Ⅰ级17例,Ⅱ级3例,Ⅲ级1例,Ⅳ级0例,Ⅴ级1例.全组死亡率8.3%.术后随访3-58个月均无再出血及动脉瘤复发.结论 动脉瘤破裂后在中期(4-10d)并不是都伴有CVS;在该期对破裂性颅内动脉瘤采用可脱性弹簧圈进行血管内囊内栓塞安全可行、疗效可靠.     

颅内动脉瘤破裂急性期血管内栓塞的疗效分析

目的分析栓塞治疗急性破裂性颅内动脉瘤的疗效及相关影响因素。方法回顾自1994—4～2004—4栓塞治疗33例急性破裂颅内动脉瘤（72h）病人,分析动脉瘤几何形态学、位置、病情严重程度、栓塞材料等对栓塞效果的影响。结果Hunt—Hess分级Ⅰ～Ⅱ级、Ⅲ级、Ⅳ-Ⅴ级者,预后良好率分别为86．9％、57．1％、0％。宽颈、窄颈动脉瘤的完全栓塞率分别为58％、76％。前交通动脉瘤、颈内动脉瘤、大脑中动脉瘤预后良好者分别为90．9％、66．7％、0％。结论动脉瘤的栓塞程度不仅与瘤颈有关,还受瘤体大小、动脉瘤位置的影响。而临床预后与Hunt-Hess分级呈负相关。     

颅内破裂动脉瘤的早期显微外科治疗

目的：本报告颅内破裂动脉瘤２４例的早期显微产治疗,方法 ２４例临床Ｈｕｎｔ ａｎｄＨｃｓｓ分别是１级５例,ＩＩ级９例,ＩＩＩ级７例,ＩＶ级２例,Ｖ级１例,入院后经脑血管造影诊断为前交通动脉瘤１２例,颈内－后交通动脉瘤９例,大脑中动脉瘤２例,颈内－脉络膜前动脉瘤１例,２４例分别于蛛网膜下腔出血后０～３ｄ内显微直接夹闭术,其中〈２４ｈ内手术１５例,２４～４８ｈ内手术５例,〈７２ｈ内手术４例,结果 ２４例中除１例Ｖ级病人于术后３ｄ死亡和１例ＩＩＩ级病人于术后２个月因颅内感染死亡飓,余２２例均获得优或良疗效,治愈率达９０．６％,结论 早期显微外科治疗颅内破裂动脉瘤,尤其对Ｈｕｎｔ Ｉ～ＩＩＩ级病人,有利于缩短住院天数,有利于降低保守治疗期间再出血的危险性。     

手术夹闭和血管内介入治疗颅内破裂动脉瘤的疗效分析

目的对手术夹闭和血管内介入治疗颅内破裂动脉瘤的疗效作初步分析。方法2004年6月至2006年6月共治疗符合入选标准的113例颅内动脉瘤病人。手术夹闭61例病人共62个动脉瘤,血管内介入栓塞52例病人共54个动脉瘤。病人术前状态采用Hunt-Hess分级,颅脑CT采用Fisher分级,术后1个月和6个月行改良Rankin评分。全部数据采用Wilcoxon秩和检验。结果手术夹闭组术前Hunt-HessⅠ～Ⅲ级53例,39例预后好,Ⅳ～Ⅴ级8例,3例预后好;术前CT Fisher分级Ⅰ～Ⅱ级35例,30例预后好,Ⅲ～Ⅳ级26例,13例预后好,术前Hunt-Hess分级和CT Fisher分级与mRS评分呈正相关。介入栓塞组术前Hunt-HessⅠ～Ⅲ级42例,33例顶后好,Ⅳ～Ⅴ级10例,2例预后好;术前CT Fisher分级Ⅰ～Ⅱ级37例,32例预后好,Ⅲ～Ⅳ级15例,7例预后好,术前Hunt-Hess分级和CT Fisher分级与mRS评分呈正相关。同一术前Hunt-Hess分级及CT Fisher分级在手术组和介入组病人中mRS评分差异无统计学意义。结论对于手术夹闭和血管内介入均适合的动脉瘤,处于同一术前Hunt-Hess分级或CT Fisher分级的病人,不论手术夹闭还是介入治疗,术后短期疗效差异无统计学意义。对于高龄、术前Hunt-Hess分级差的病人首选介入治疗。两种治疗办法的长期疗效对比仍有待于研究。     

颅内破裂动脉瘤血管内介入治疗时机的选择及其对病人预后的影响

目的 探讨颅内破裂动脉瘤血管内介入治疗时机的选择及其对病人预后的影响。方法 回顾性分析2018年1月至2020年6月血管内介入治疗的149例颅内破裂动脉瘤的临床资料。手术时机分为早期手术（≤72 h）和晚期手术（>72 h）。术后随访6个月,采用改良Rankin量表（mRS）评分评估预后,其中0～2分为预后良好,3～6分为预后不良。结果 术后6个月,110例（73.8%）预后良好;39例（26.2%）预后不良,其中死亡12例。本文149例中,早期手术96例,晚期手术53例。早期手术预后良好率（82.3%,79/96）明显高于晚期手术（55.4%,31/56;P<0.05）。多因素logistic回归分析显示,晚期手术是颅内破裂动脉瘤预后不良的独立危险因素（P<0.05）。结论 对于颅内破裂动脉瘤,早期手术可改善病人的预后。     

颅内动脉瘤破裂早期血管内治疗

目的分析栓塞治疗急性破裂的颅内动脉瘤的疗效。方法回顾栓塞治疗的29例急性期(72 h)病人,分析栓塞治疗的临床结果。结果填塞程度达95%以上22例,90%~95%7例。半年后有19例行DSA复查,其中19例示载瘤动脉通畅,动脉瘤未显影,2例示动脉瘤颈部显影。结论在动脉瘤破裂的急性期栓塞治疗可收到相当好的治疗效果。     

颅内动脉瘤显微手术治疗及效果分析

目的探讨显微手术治疗颅内动脉瘤的疗效。方法回顾性分析我院2008—2010年经显微外科手术夹闭治疗颅内动脉瘤92例的临床资料。结果所有病例均全麻下行动脉瘤瘤颈夹闭术,GOS愈后评分结果:良好61例,轻度病残16例,中度病残6例,重度病残4例,死亡5例。结论尽早手术治疗、熟练的显微神经外科技术、载瘤动脉穿支血管的保护、瘤颈的充分显露、术中破裂动脉瘤的处理、以及安全平稳的麻醉是成功手术的要素。     

颅内动脉瘤破裂急性期血管内栓塞治疗的疗效分析及影响因素

目的分析栓塞治疗急性破裂的颅内动脉瘤的疗效及相关影响因素。方法回顾自1994年4月至2004年4月急性期(72h)颅内动脉瘤栓塞治疗的33例病人,分析动脉瘤几何形态学、位置、病情严重程度等对栓塞效果及临床治疗的影响。结果Hunt-Hes分级Ⅰ～Ⅱ级、Ⅲ级、Ⅳ级者,预后良好率分别为87.0%(20/23)、57.1%(4/7)、0%(0/3)。宽颈、窄颈动脉瘤的完全栓塞率分别为58.3%(7/12)、76.2%(16/21)。前交通动脉瘤颈内动脉瘤、预后良好者分别为90.9%(10/11)、66.7%(12/18)。结论动脉瘤的栓塞程度受瘤颈、瘤体大小、动脉瘤位置等因素的影响,临床预后与Hunt-Hess分级呈负相关。     

Endovascular treatment of ruptured tiny intracranial aneurysms

Endovascular treatment of ruptured tiny intracranial aneurysms (RTIA) is technically challenging. We retrospectively collected and analyzed the clinical data of 51 patients with RTIA who underwent attempted endovascular treatment at our institution between November 2000 and April 2009. Forty-nine patients were successfully treated by coiling alone (29 patients), stent-assisted coiling (11 patients) or stent placement alone (nine patients). Procedural complications occurred in five patients. One patient died from a severe initial hemorrhage and poor clinical condition. At the time of discharge, 44 patients (89.8%) had recovered in good condition (Glasgow Outcome Scale [GOS] score 5), two were moderately disabled (GOS score 4) and two were severely disabled (GOS score 3). Angiographic follow-up (mean follow-up time = 14 months) was available for 33 patients, and two were re-treated. None of the 46 patients who were clinically followed up (mean = 54.2 months) experienced re-bleeding. Our results suggest that RTIA is not uncommon and can be safely treated endovascularly.     

颅内动脉瘤显微外科手术163例分析

目的 总结颅内动脉瘤显微外科手术的治疗经验。方法 统计近年２年来显微外科手术夹闭的１６３例颅内动脉瘤患者的临床资料、手术方式及术后转归。结果 成功夹闭１６２例,５例为栓塞失败后改为手术夹闭。术中过早破裂３１例,其中１例在切开脑膜前破裂,未予夹闭。１１２例恢复正常工作（６９．９％）,轻残１９例,重度残废２１例,死亡８例（４．９％）,术后脑积水３２例。结论 颅内动脉瘤一旦诊断明确,即应积极处理,Ｈｕｎ     

Whole-brain CT perfusion combined with CT angiography for ischemic complications following microsurgical clipping and endovascular coiling of ruptured intracranial aneurysms

Ischemic complications associated with microsurgical clipping and endovascular coiling affects the outcome of patients with intracranial aneurysms. We prospectively evaluated 58 intracranial aneurysm patients who had neurological deterioration or presented with poor grade (Hunt-Hess grades III and IV), aneurysm size >13 mm and multiple aneurysms after clipping or coiling. Thirty patients had ischemic complications (52%) as demonstrated by whole-brain CT perfusion (WB-CTP) combined with CT angiography (CTA). Half of these 30 patients had treatment-associated reduction in the diameter of the parent vessels (n = 6), ligation of the parent vessels or perforating arteries (n = 2), and unexplained or indistinguishable vascular injury (n = 7); seven of these 15 (73%) patients suffered infarction. The remaining 15 patients had disease-associated cerebral ischemia caused by generalized vasospasm (n = 6) and focal vessel vasospasm (n = 9); six of these 15 (40%) patients developed infarction. Three hemodynamic patterns of ischemic complications were found on WB-CTP, of which increased time to peak, time to delay and mean transit time associated with decreased cerebral blood flow and cerebral blood volume were the main predictors of irreversible ischemic lesions. In conclusion, WB-CTP combined with CTA can accurately determine the cause of neurological deterioration and classify ischemic complications. This combined approach may be helpful in assessing hemodynamic patterns and monitoring operative outcomes.     

颅内宽颈动脉瘤出血急性期的血管内治疗

目的探讨出血急性期血管内栓塞治疗颅内宽颈动脉瘤的临床效果。方法回顾性分析出血后72h内经血管内栓塞治疗的28例破裂的颅内宽颈动脉瘤患者的临床资料。结果28例中完全致密栓塞20例,栓塞程度达90％以上者6例,栓塞程度在80％-90％者2例。术后无再出血发生,死亡1例。结论Hunt—Hess分级I～Ⅳ级颅内宽颈动脉瘤出血急性期患者实施血管内治疗安全可靠,可避免动脉瘤再次破裂出血,明显降低患者的死亡率和致残率。     

微弹簧圈囊内栓塞急性出血期颅内动脉瘤

目的　急性出血期颅内动脉瘤的微弹簧圈囊内栓塞。方法　股动脉或颈动脉 Ｓｅｌｄｉｎｇｅｒ○ｓ 穿刺。用ｐｕｓｈｅｒ 推入自制弹簧圈或用 Ｍ Ｄ Ｓ 系统送入合适长度的微弹簧圈到动脉瘤腔内填塞动脉瘤腔。结果　本组无一例死亡。４２ 例动脉瘤中３８ 例 （９０ ％ ） 术后立即造影动脉瘤完全栓塞， 另外４ 例（１０ ％ ） 动脉瘤部分栓塞。２０ 例病人接受 Ｄ Ｓ Ａ 复查均未见动脉瘤复发。不全栓塞的４ 例动脉瘤中１ 例后交通动脉瘤半年后行 Ｄ Ｓ Ａ 见动脉瘤颈部扩大， 行二次栓塞， １ 例基底动脉瘤半年后虽经二次栓塞治疗， 一年后复查病人动脉瘤仍在继续扩大， １ 例椎动脉瘤和１ 例前交通动脉瘤 Ｄ Ｓ Ａ 复查见动脉瘤腔已完全闭塞。结论　对于囊状动脉瘤 Ｓ Ａ Ｈ 急性期的病人， 微弹簧圈动脉瘤腔内栓塞治疗是较为安全有效的方法。     

Hunt-HessⅣ、Ⅴ级颅内动脉瘤手术治疗的分析

目的总结Hunt-HessⅣ、Ⅴ级颅内动脉瘤手术治疗的经验。方法2000年1月至2012年2月手术治疗216例Hunt-HessⅣ、Ⅴ级颅内动脉瘤,其中Ⅳ级192例,Ⅴ级24例。手术夹闭动脉瘤,同时清除颅内血肿,并酌情行去骨瓣减压术。结果术后6个月按GOS评分,Hunt-HessⅣ级192例患者中,预后良好38例,轻残56例,重残60例,植物生存15例,死亡23例;死亡率12.0%。Hunt-HessⅤ级24例患者中,重残5例,植物生存4例,死亡15例;死亡率62.5%。结论对于合并颅内血肿的Hunt-HessⅣ级动脉瘤患者应积极手术治疗。Hunt-HessⅤ级患者手术疗效极差,应该待临床症状稳定后再行治疗。     

早期栓塞术治疗动脉瘤性蛛网膜下腔出血的疗效

目的 探讨早期（72 h内）栓塞术对动脉瘤性蛛网膜下腔出血并发症及预后的影响。方法 回顾性分析2012年1月至2015年12月收治的动脉瘤性蛛网膜下腔出血102例的临床资料,其中有53例采用早期栓塞术治疗（观察组）,另外49例采用显微夹闭术治疗（对照组）。术后6个月按GOS评分评估预后。结果 观察组手术时间、术中出血量以及术后住院时间均显著优于对照组（P<0.05）;两组并发症发生率和预后比较无显著差异（>P>0.05）。结论 和夹闭术相比较,早期栓塞术在缩短手术时间和住院时间、减少术中出血量方面作用更为显著;但两种手术方式治疗的预后无明显差异。     

A comparison of endovascular strategies in the treatment of ruptured vertebral artery aneurysms

BackgroundContemporary management of ruptured vertebral artery dissecting aneurysms (VADA) has evolved beyond proximal parent artery occlusion (PPAO) to include endovascular trapping (ET) of the diseased segment and vessel preserving stent treatments. The aim of this retrospective cohort study was to assess the outcomes of patients with ruptured VADAs who underwent endovascular management with trapping of the diseased segment as the first-line treatment approach.MethodsWe evaluated an institutional database of patients with ruptured VADAs who were treated at Auckland City Hospital from 1998 to 2017. Baseline and outcomes data were analyzed. High-grade SAH was defined as a World Federation of Neurological Surgeons or a Hunt and Hess grade of IV-V. Favorable outcome was defined as a modified Rankin Scale of 0–2.ResultsThe study cohort was comprised of 45 ruptured VADA patients with a mean age of 50 years. The mean follow-up duration was 12.9 months. ET of the diseased segment was performed in 32 cases (71.1%), PPAO of the VA was performed in 12 cases (26.7%) and reconstruction using a flow diverting stent was performed in 1 case (2.2%). The overall procedural complication rate was 13%, including procedural neurological morbidity in 4.4%. At last follow-up, no further aneurysm filling was seen in any case, and 77.8% had a favorable outcome.ConclusionET affords a favorable risk to benefit profile for patients with ruptured VADAs. ET remains a reasonable option for ruptured VADAs in patients with sufficient collateral supply to the vertebrobasilar system.