介入栓塞治疗112例颅内动脉瘤

目的探讨介入栓塞治疗颅内动脉瘤的效果和经验。方法采用神经安定麻醉加局麻或全麻加局麻,经股动脉穿刺入路,在数字减影血管造影监视下,经导引导管将微导管头端送入动脉瘤腔,根据动脉瘤的形状、大小选用合适的弹簧圈,逐步将瘤腔填塞满意。7例宽颈或梭形动脉瘤行支架结合弹簧圈栓塞,3例宽颈动脉瘤应用球囊瘤颈塑型弹簧圈栓塞术,3例小脑后下动脉远端动脉瘤行NBCA胶栓塞,1例颈内动脉巨大动脉瘤行载瘤动脉闭塞。出血较多的病例术后行腰大池持续引流3~7 d。术后随访2~89个月。结果112例共118个动脉瘤中,行栓塞117个,其中100%栓塞93个(78.8%),90%栓塞17个(14.4%),80%栓塞3个(2.5%),50%栓塞2个(1.7%),栓塞失败2个(占1.7%);1个多发动脉瘤未作处理。10例应用瘤颈辅助技术,疗效满意。术后随访发现,3例再发蛛网膜下腔出血;5例动眼神经麻痹患者中4例恢复,1例明显好转。结论介入栓塞术适合大多数颅内动脉瘤的治疗,且疗效满意。

Endovascular Treatment of 112 Cases with Intracranial Aneurysms

Objective To assess the effect of endovascular treatment on intracranial aneurysm. Methods Under local or general anesthesia and after systematic anticoagulation,a micro-catheter was navigated into the aneurysm through a guide catheter.Then,the aneurysms were embolized with coil which was introduced by the micro-catheter.Seven wide-neck aneurysms were embolized with the stent and the coil.Three wide-nick aneurysms were embolized using remodeling technique and three distal posterior inferior cerebellar artery aneurysms were embolized with NBCA.Continuous spinal drainage and medication were performed after therapy.Angiography was performed before,during and after embolization.Patients were followed for 2 to 89 months. Results One hundred and seventeen of 118(aneurysms) in 112 cases were embolized.100% occlusion was achieved in 93 aneurysms(78.8%),90% in 17((14.4%),) 80% in 3(2.5%),and 50% in 2(1.7%).Two cases failed to be embolized(1.7%).One coincidental unruptured aneurysm was not embolized.Ten cases using stent or remodeling technique were well recovered.Rebleeding occurred in three cases after treatment.Four of the five cases presented with oculomotor paralysis were completely recovered,another case was improved. Conclusion Embolization of intracranial aneurysms with coil is safe,effective and reliable.