Diagnostic imaging of cerebrovascular disease on multi-detector row computed tomography (MDCT)

In this study, we reviewed characteristic diagnostic findings of vascular diseases in the central nervous system with 3-dimensional computed tomographic angiography (3D-CTA) using multi-detector row computed tomography (MDCT) and a novel 320-row area detector CT (320-ADCT). With coverage of 160 mm in a single rotation, 320-ADCT enables acquisition of both 4-dimensional CT angiography (dynamic 4D-CTA) and whole-brain CT perfusion imaging. We describe our experience of investigating cerebrovascular diseases with MDCT and 320-ADCT, as well as several postprocessing techniques to acquire images useful for diagnosis, therapy planning, and simulation of neurosurgical and endovascular intervention. 3D-CTA demonstrates has high accuracy in detecting and evaluating cerebral aneurysms and steno-occlusive diseases. Angiographic analysis, including information of surrounding tissues on 3D-CTA, allows assessment of the feasibility of neurosurgical or endovascular approaches and the technique to accomplish the therapy. However, 3D-CTA using MDCT is limited in its detection of aneurysms less than 3 mm in size and aneurysms embedded in the skull base region. In addition, discrimination between intradural paraclinoid aneurysms and extradural intracavernous aneurysms remains an unresolved problem in imaging of cerebral aneurysms. 320-ADCT may solve this problem with its high accuracy in discriminating arteries from the venous system. 3D-CTA could be used as an alternative to DSA for detection of severe carotid artery disease. 3D-CTA enables measurement of the lesions, plaque imaging, prediction of anatomical variants, screening for asymptomatic vascular lesions, and exclusion of patients with risk factors from carotid endoarterectomy (CEA) or carotid artery stenting (CAS). The diagnosis of intracranial dural arteriovenous fistula (DAVF) with CTA is challenging. Recently, several authors proposed diagnostic findings of ADVF by CTA and reported high sensitivity and specificity. 320-ADCT may offer comprehensive information for diagnosis and therapy planning of intracranial DAVF. Although DSA is a standard modality to detect spinal vascular malformations, selective catheterization requires considerable time and a certain amount of contrast medium, and is associated with a risk of neurological complications. Spinal 3D-CTA prior to DSA is useful in selective catheterization to arteries at certain spinal levels as well as when considering treatment options and therapy planning.     

三维数字减影血管造影在脑动脉瘤治疗和随访中的应用

目的　探讨三维数字减影血管造影 (3DDSA)在脑动脉瘤血管内栓塞治疗及随访中的价值。方法　对 4 9例疑诊或确诊动脉瘤的病例 ,术前、栓塞术中行 3DDSA检查 ,其中 10例作 3DDSA随访。结果　 4 9例中经 3DDSA证实共检出 4 7例 5 3个动脉瘤 ,3DDSA对动脉瘤形状、瘤颈及瘤颈与载瘤血管关系能更好地显示 ,准确判断动脉瘤血管内栓塞的可行性 ,并为栓塞治疗提供最佳工作角度。 12例病人因 3DDSA检查而改变了原来的治疗方法。3DDSA尚可准确判断动脉瘤的栓塞程度及有无复发。结论　 3DDSA可提高颅内动脉瘤血管内栓塞的安全性 ,并有助于随访研究。     

3D DSA辅助下弹簧圈栓塞颅内微型动脉瘤

目的探讨三维数字减影血管造影(3D DSA)辅助下应用弹簧圈血管内栓塞治疗颅内微型动脉瘤的技术要点及疗效。方法回顾性分析自2005年1月至2008年12月,23例颅内微型动脉瘤患者临床资料(瘤体最大径≤3.0 mm),全部经二维造影及三维重建,并行血管内介入治疗。结果 3D DSA在诊断此类动脉瘤方面最为精确,7例2D DSA定诊为阴性后,3D DSA检查发现动脉瘤,我们定义宽颈动脉瘤体颈比<1.5,2D DSA为13例(81.3%),3D DSA为11例(47.8%),在统计学上有显著差异(P<0.05);23例动脉瘤全部栓塞成功,其中致密栓塞7例,次全栓塞8例,部分栓塞8例,球囊辅助1例,支架辅助3例。术中颅内动脉瘤破裂出血3例,无死亡病例。脑血管造影复查5例,4例动脉瘤稳定,1例复发。所有患者随访中改良Rantin评分为0～1,生活可自理。结论 3D DSA在颅内微型动脉瘤的诊断和介入治疗中有重要的辅助作用,应用弹簧圈血管内栓塞治疗颅内微型动脉瘤疗效确切,术中微导管和弹簧圈技术是成功的关键。     

Results of endovascular treatment of aneurysms depending on their size,volume and coil packing density

Background and purposeIn contrast to neurosurgery, which is more efficient, endovascular treatment (EVT) is less invasive. The main purpose of EVT is complete occlusion of the aneurysm and protection from subarachnoid haemorrhage. Accurate measurements of the aneurysm (size, volume) obtained using a 3D digital subtraction angiography (DSA) workstation can assist in the proper assessment of coil packing density (CPD), which affects possible distant recanalization. The main disadvantage of endovascular treatment of intracranial aneurysms compared to neurosurgery is the high recurrence rate. We evaluated the results of endovascular treatment of aneurysms depending on their size, volume and coil packing density.Material and methodsThirty-five patients with intracranial aneurysms underwent endovascular embolization with bare platinum coils. Three-dimensional DSA was used to evaluate aneurysms’ morphology. Eighteen patients underwent 3D DSA follow-up 6-45 months after treatment. Initial and follow-up results of embolization were assessed with the Raymond-Montreal scale. The impact of aneurysms’ morphology, volume and initial CPD on endovascular treatment was evaluated.ResultsAmong 35 patients, complete initial embolization was achieved in 74%. Mean initial aneurysm volume in 3D DSA was 0.517 mL and decreased significantly after embolization. Initial CPD varied from 74% to 2% depending on aneurysm diameter (12.1% for aneurysms ≥ 10 mm, 22.5% for aneurysms < 10 mm). Results of embolization on the Raymond-Montreal scale significantly depended on aneurysms’ CPD. Aneurysms’ recanalization rate on 3D DSA follow-up was 36%, with complete recanalization in 3.3%.ConclusionsWe can achieve a better outcome if size and volume of the aneurysm sac is smaller and if CPD is higher.     

Blister-like aneurysms of the supraclinoid internal carotid artery: Challenging endovascular treatment with stent-assisted coiling

'Blister-like' aneurysms of the supraclinoid segment of the internal carotid artery are usually small and have fragile walls, necessitating special care to prevent rebleeding. These lesions are considered high-risk aneurysms because of the technical difficulties associated with their surgical and endovascular treatment. In this report, we describe the use of stent-assisted, repeated coil embolization in the treatment of a ruptured blister-like aneurysm that experienced rapid growth. Stent-assisted coil embolization is an alternative, but sometimes hazardous, treatment for select blister-like aneurysms. Careful serial follow-up angiography will provide documentation as to the long-term stability of the endovascularly treated blister-like aneurysm described here, but early results are encouraging. Alternatively, placement of telescoped stents or graft-stent devices offers promise for future endovascular therapy.     

旋转DSA及三维重建在颅内动脉瘤诊断中的价值

目的探讨三维旋转DSA对颅内动脉瘤的诊断价值。方法使用荷兰PHILIPS公司数字减影机．对20例疑有动脉瘤的蛛网膜下腔出血患者作旋转DSA检查．并行三维重建，再与常规DSA检查比较．得到关于动脉瘤的定位、动脉瘤清晰度、瘤颈及血管分支的解剖图像。结果常规DSA检查发现16例16个动脉瘤．其中3例3个动脉瘤的方向和载瘤动脉及周围血管解剖关系显示不清，1例1个动脉瘤的颈部显示不清；4例阴性。加摄旋转DSA检查并行三维重建后，明确诊断颅内动脉瘤的18例18个．2例未见动脉瘤；且动脉瘤的全貌．瘤颈的位置与结构及周围血管分支的解剖关系显示清晰．避免了因血管重叠而产生的对动脉瘤的遮挡。结论旋转DSA可更好、更清晰的连续显示动脉瘤的颈部及周围的血管解剖结构，加三维重建后动脉瘤的大小、方向、与载瘤动脉周围血管的关系成立体解剖结构．即提高了动脉瘤的血管造影诊断准确性．又为手术和介入治疗提供更为准确的参考价值。     

血管造影计算机断层成像在脑血管病诊治中应用价值的研究

目的研究一种新的影像学技术——血管造影计算机断层成像（ACT）在脑斑管病诊断和治疗中的应用价值。方法对240例脑血管病病人采用GE公司Innova3100平板血管造影机进行InnovaCT扫描，图像经过AW工作站后处理．获得InnovaCT图像，并结合3D—DSA及螺旋CT图像等进行分析。结果InnovaCT在发现颅内新鲜出血方面和螺旋CT具有很好的一致性；InnovaCT还可以将血管病变影像和CT图像融合在一起，了解其与颅底骨质、颅内结构等的关系：有助于判断不同血管内栓塞材料的治疗效果，指导临床治疗。结论InnovaCT可以提高医生对脑血管病的认识，提高血管内治疗的安全性和有效性．但其临床价值还有待进一步深入研究。     

Extravasation during Aneurysm Embolization without Neurologic Consequences. Lessons learned from Complications of Pseudoaneurysm Coiling. Report of 2 Cases

Although endovascular intervention is the first-line treatment of intracranial aneurysm, intraprocedural rupture or extravasation is still an endangering event. We describe two interesting cases of extravasation during embolotherapy for ruptured peripheral cerebral pseudoaneurysms. Two male patients were admitted after development of sudden headache with presentation of intracerebral and subarachnoid hemorrhage, respectively. Initial angiographic assessment failed to uncover any aneurysmal dilatation in both patients. Two weeks afterwards, catheter angiography revealed aneurysms each in the peripheral middle cerebral artery and anterior inferior cerebellar artery. Under a general anesthesia, endovascular embolization was attempted without systemic heparinization. In each case, sudden extravasation was noted around the aneurysm during manual injection of contrast after microcatheter navigation. Immediate computed tomographic scan showed a large amount of contrast collection within the brain, but they tolerated and made an unremarkable recovery thereafter. Intraprocedural extravasation is an endangering event and needs prompt management, however proximal plugging with coil deployment can be sufficient alternative, if one confronts with peripheral pseudoaneurysm. Peculiar angiographic features are deemed attributable to extremely fragile, porous vascular wall of the pseudoaneurysm. Accordingly, it should be noted that extreme caution being needed to handle such a friable vascular lesion.     

前交通动脉瘤介入治疗效果分析

目的探讨颅内前交通动脉瘤介入治疗方法和技术操作要点。 方法选取新疆医科大学附属中医医院神经外一科自2013年7月至2018年8月收治的15例前交通动脉瘤患者,其中12例破裂动脉瘤,3例未破裂动脉瘤。按Hunt-Hess分级：0级3例,Ⅱ级8例,Ⅲ级3例,Ⅳ级1例。6例患者采用3D弹簧圈成篮编织技术治疗,9例患者采用血管内支架辅助技术治疗。 结果动脉瘤腔致密栓塞15例,栓塞程度达90%以上者10例（66.7%）,栓塞程度在70%~90%者5例（33.3%）,无死亡病例。 结论3D弹簧圈成篮编织技术与血管内支架辅助技术均可达到前交通动脉瘤治愈的目的。     

Angiogram-negative subarachnoid hemorrhage in the era of three dimensional rotational angiography.

BACKGROUND: Three dimensional rotational angiography (3DRA) is a powerful method for depicting intracranial vascular lesions because of its 3D imaging capability. The purpose of this study was to analyse if 3DRA had reduced the incidence of angiogram-negative subarchnoid haemorrhage (SAH) and which type of aneurysm tended to be overlooked with conventional digital subtraction angiography. METHOD: Angiogram-negative SAH was defined as present in those patients with SAH who had no demonstrable lesion revealed by more than two adequate cerebral angiograms. From January 1, 1992, to December 31, 2004, angiography was performed on 247 patients at the Yamaguchi University Hospital. Digital subtraction angiography (DSA) alone was used for 105 patients (DSA group) from 1992 to 2000. After the technology of 3DRA was introduced to our hospital in 2000, 142 patients were evaluated by 3DRA and DSA together (3DRA group). FINDINGS: The incidence of angiogram-negative SAH was 9/105 (8.6%) in the DSA group and 6/142 (4.2%) in the 3DRA group. 3DRA revealed six aneurysms not depicted by the conventional DSA, including a basilar tip aneurysm, anterior cerebral artery aneurysm and a basilar tip aneurysm originating from a previously clipped aneurysm. CONCLUSION: Three dimensional RA is more sensitive in detecting aneurysms, but in our study still produced a 4.2% rate of angiogram-negative SAH. Three dimensional RA has some advantages for evaluation, especially of complicated sites and previously clipped aneurysms because of its three dimensional imaging capability.     

急诊夹闭与栓塞治疗颅内破裂动脉瘤的疗效初析

目的:比较急诊动脉瘤夹闭术和血管内介入栓塞术治疗颅内破裂动脉瘤的疗效。方法:对62例颅内破裂动脉瘤急诊治疗,其中开颅夹闭组39例、栓塞组23例。术后随访3~28个月,夹闭组31例、栓塞组22例(失随访9例)。结果:夹闭组治愈30例,栓塞组治愈20例(P<0·01)。术中动脉瘤破裂:夹闭组5例;围手术期死亡:夹闭组3例;下视丘反应:夹闭组8例、栓塞组3例;认知和肢体功能障碍:夹闭组2例、栓塞组1例;植物状态:夹闭组1例。随访:夹闭组1例死亡。结论:急诊血管内栓塞术操作安全、疗效优于开颅夹闭术,特别是对Hunt-Hess(H&H)分级为Ⅳ~Ⅴ级的患者可增加生存和治愈机会,但不能完全替代夹闭术,两者的远期效果需进一步观察。     

Three-dimensional CT angiography in the evaluation of cerebral arteries in acute hemorrhage

OBJECTIVE: We conducted this study to demonstrate the value of non-invasive three-dimensional CT angiography (3D CTA) in the detection of a cerebral aneurysm. MATERIAL AND METHODS: A helical CT acquisition was obtained using non-ionic contrast media in 50 patients with 1 mm per second table speed, 1 mm collimation, and pitch 1:1. Axial source images were transferred into a workstation console (Advantage windows GE) and CTA was obtained using MIP (Maximum Intensity Projection) reconstruction. Fourteen patients underwent conventional digital subtraction angiography (DSA) after 3D CTA prior to surgery. RESULTS: A total of 39 aneurysms were detected in 50 patients. All patients with an aneurysm were operated and the presence of aneurysms was confirmed. 3D CTA detected 38 of these 39 aneurysms. In 37 aneurysms, the origin of the aneurysm and aneurysm neck was adequately visualized. 3D CTA was found to be 100% specific and 97.2% sensitive in picking up cerebral aneurysms. 3D CTA was 97% specific in demonstrating the exact origin and showing the neck of the aneurysm. CONCLUSIONS: CT angiography is a simple, quick, and non-invasive technique and can replace DSA in most patients with acute subarachnoid hemorrhage aneurysm for the detection and characterization of aneurysms of the circle of Willis. The relation of the aneurysm with bony landmarks was clearly depicted.     

颅内动静脉畸形合并动脉瘤的血管内治疗

目的 总结血管内治疗颅内动静脉畸形(AVM)合并动脉瘤的经验.方法 回顾性分析25例颅内AVM合并动脉瘤的临床资料.所有病例均经全脑血管造影(DSA)确诊,按照Redekop分型进行治疗.结果 动脉瘤完全栓塞23例,部分栓塞2例.畸形血管团完全消失7例,消失90％以上9例,消失80％～90％7例,消失80％以下2例.栓塞后手术切除12例,栓塞后伽玛刀治疗6例.所有病人均未出现与血管内治疗相关的并发症.随访25例,时间0.5～3年,无再次出血及死亡.DSA复查18例,其中动脉瘤和畸形血管团均不显影14例,动脉瘤不显影但畸形血管团少许残留4例.结论血管内治疗是颅内AVM合并动脉瘤安全、有效的治疗方法,Redekop分型可对其治疗提供指导.     

新型带纤毛弹簧圈栓塞治疗颅内动脉瘤的临床研究

目的 探讨新型带纤毛弹簧罔栓塞治疗颅内动脉瘤的临床疗效. 方法 南方医科大学珠江医院神经外科自2008年3月至9月共收治41例颅内动脉瘤患者(43个动脉瘤),均用新型带纤毛弹簧罔栓塞治疗.回顾性分析患者随访情况,随访时间6～12个月,行脑血管造影或CT脑血管成像或磁共振脑血管成像,了解颅内动脉瘤复发及并发症情况. 结果 41例患者中死亡1例,术后并发脑梗死2例,动眼神经麻痹1例,复发1例,脑积水2例;改良Rankin评分量表评级为0级9例,1级19例,2级7例,3级3例,4级1例,5级和6级各1例. 结论 新型带纤毛弹簧圈栓塞治疗颅内动脉瘤安全有效,对小动脉瘤(<5 mm)有相对优势,对载瘤动脉闭塞有一定优势;但对大脑前动脉、大脑中动脉等较细载瘤动脉,因纤毛的致栓作用可能会造成脑梗死,因此封闭瘤颈时应用此罔要谨慎.     

Endovascular occlusion of basilar bifurcation aneurysms with electrolytically detachable coils.

OBJECT: To describe the clinical and angiographic results of endovascular occlusion of basilar bifurcation aneurysms with electrolytically detachable coils, and to identify factors which should be considered in deciding upon surgical or endovascular treatment. METHODS: We report our experience with 40 patients in whom occlusion of basilar bifurcation aneurysms with electrolytically detachable coils was attempted. All patients underwent superselective angiography and attempted embolization with Guglielmi detachable coils (GDCs). Angiographic and clinical results were prospectively recorded. Twenty-eight aneurysms presented with subarachnoid hemorrhage (SAH), 2 were symptomatic and 10 were incidental. RESULTS: Coils were not placed in 10 patients (25%) because of unfavorable anatomy. Complete aneurysm occlusion was achieved at the time of the initial procedure in 13 (32.5%), small neck remnants were present in 13 (32.5%), and in 4 (10.0%) there was obvious residual contrast filling of the aneurysm body. Of 23 patients successfully coiled after SAH, 20 were Grade 1 to 3 and 3 were grade 4 or 5 at the time of treatment. Eighteen (78%) made a good recovery. Procedural mortality was 2.5% and permanent morbidity was 7.5%. There were no permanent complications in patients with unruptured aneurysms. Complete aneurysm occlusion was possible in 10 (56%) of 18 aneurysms with small necks and 3 (14%) of 22 with large necks. Follow-up angiography in 25 of 28 surviving patients (mean, 12 months) demonstrated stability of all completely occluded aneurysms. Incompletely coiled aneurysms had variable results on follow-up angiograms: 15.4% improved, 69.2% worsened, and 15.4% were stable. No aneurysm bled after treatment during clinical follow-up averaging 22 months. CONCLUSIONS: Endovascular treatment of basilar bifurcation aneurysms appears to prevent early aneurysm rebleeding with acceptable rates of morbidity and mortality, but long-term follow-up is required.     

新型带纤毛弹簧圈栓塞治疗颅内动脉瘤的临床研究

目的 探讨新型带纤毛弹簧罔栓塞治疗颅内动脉瘤的临床疗效. 方法 南方医科大学珠江医院神经外科自2008年3月至9月共收治41例颅内动脉瘤患者(43个动脉瘤),均用新型带纤毛弹簧罔栓塞治疗.回顾性分析患者随访情况,随访时间6～12个月,行脑血管造影或CT脑血管成像或磁共振脑血管成像,了解颅内动脉瘤复发及并发症情况. 结果 41例患者中死亡1例,术后并发脑梗死2例,动眼神经麻痹1例,复发1例,脑积水2例;改良Rankin评分量表评级为0级9例,1级19例,2级7例,3级3例,4级1例,5级和6级各1例. 结论 新型带纤毛弹簧圈栓塞治疗颅内动脉瘤安全有效,对小动脉瘤(<5 mm)有相对优势,对载瘤动脉闭塞有一定优势;但对大脑前动脉、大脑中动脉等较细载瘤动脉,因纤毛的致栓作用可能会造成脑梗死,因此封闭瘤颈时应用此罔要谨慎.     

新型带纤毛弹簧圈栓塞治疗颅内动脉瘤的临床研究

目的 探讨新型带纤毛弹簧罔栓塞治疗颅内动脉瘤的临床疗效. 方法 南方医科大学珠江医院神经外科自2008年3月至9月共收治41例颅内动脉瘤患者(43个动脉瘤),均用新型带纤毛弹簧罔栓塞治疗.回顾性分析患者随访情况,随访时间6～12个月,行脑血管造影或CT脑血管成像或磁共振脑血管成像,了解颅内动脉瘤复发及并发症情况. 结果 41例患者中死亡1例,术后并发脑梗死2例,动眼神经麻痹1例,复发1例,脑积水2例;改良Rankin评分量表评级为0级9例,1级19例,2级7例,3级3例,4级1例,5级和6级各1例. 结论 新型带纤毛弹簧圈栓塞治疗颅内动脉瘤安全有效,对小动脉瘤(<5 mm)有相对优势,对载瘤动脉闭塞有一定优势;但对大脑前动脉、大脑中动脉等较细载瘤动脉,因纤毛的致栓作用可能会造成脑梗死,因此封闭瘤颈时应用此罔要谨慎.     

新型带纤毛弹簧圈栓塞治疗颅内动脉瘤的临床研究

目的 探讨新型带纤毛弹簧罔栓塞治疗颅内动脉瘤的临床疗效. 方法 南方医科大学珠江医院神经外科自2008年3月至9月共收治41例颅内动脉瘤患者(43个动脉瘤),均用新型带纤毛弹簧罔栓塞治疗.回顾性分析患者随访情况,随访时间6～12个月,行脑血管造影或CT脑血管成像或磁共振脑血管成像,了解颅内动脉瘤复发及并发症情况. 结果 41例患者中死亡1例,术后并发脑梗死2例,动眼神经麻痹1例,复发1例,脑积水2例;改良Rankin评分量表评级为0级9例,1级19例,2级7例,3级3例,4级1例,5级和6级各1例. 结论 新型带纤毛弹簧圈栓塞治疗颅内动脉瘤安全有效,对小动脉瘤(<5 mm)有相对优势,对载瘤动脉闭塞有一定优势;但对大脑前动脉、大脑中动脉等较细载瘤动脉,因纤毛的致栓作用可能会造成脑梗死,因此封闭瘤颈时应用此罔要谨慎.     

新型带纤毛弹簧圈栓塞治疗颅内动脉瘤的临床研究

目的 探讨新型带纤毛弹簧罔栓塞治疗颅内动脉瘤的临床疗效. 方法 南方医科大学珠江医院神经外科自2008年3月至9月共收治41例颅内动脉瘤患者(43个动脉瘤),均用新型带纤毛弹簧罔栓塞治疗.回顾性分析患者随访情况,随访时间6～12个月,行脑血管造影或CT脑血管成像或磁共振脑血管成像,了解颅内动脉瘤复发及并发症情况. 结果 41例患者中死亡1例,术后并发脑梗死2例,动眼神经麻痹1例,复发1例,脑积水2例;改良Rankin评分量表评级为0级9例,1级19例,2级7例,3级3例,4级1例,5级和6级各1例. 结论 新型带纤毛弹簧圈栓塞治疗颅内动脉瘤安全有效,对小动脉瘤(<5 mm)有相对优势,对载瘤动脉闭塞有一定优势;但对大脑前动脉、大脑中动脉等较细载瘤动脉,因纤毛的致栓作用可能会造成脑梗死,因此封闭瘤颈时应用此罔要谨慎.     

新型带纤毛弹簧圈栓塞治疗颅内动脉瘤的临床研究

目的 探讨新型带纤毛弹簧罔栓塞治疗颅内动脉瘤的临床疗效. 方法 南方医科大学珠江医院神经外科自2008年3月至9月共收治41例颅内动脉瘤患者(43个动脉瘤),均用新型带纤毛弹簧罔栓塞治疗.回顾性分析患者随访情况,随访时间6～12个月,行脑血管造影或CT脑血管成像或磁共振脑血管成像,了解颅内动脉瘤复发及并发症情况. 结果 41例患者中死亡1例,术后并发脑梗死2例,动眼神经麻痹1例,复发1例,脑积水2例;改良Rankin评分量表评级为0级9例,1级19例,2级7例,3级3例,4级1例,5级和6级各1例. 结论 新型带纤毛弹簧圈栓塞治疗颅内动脉瘤安全有效,对小动脉瘤(<5 mm)有相对优势,对载瘤动脉闭塞有一定优势;但对大脑前动脉、大脑中动脉等较细载瘤动脉,因纤毛的致栓作用可能会造成脑梗死,因此封闭瘤颈时应用此罔要谨慎.