造影“误判”失去介入治疗机会的颅内动脉瘤

目的对因神经影像判断失去介入治疗机会的动脉瘤,探讨是否能够栓塞治疗。方法 6例脑血管造影发现动脉瘤与分支关系显示不清,瘤颈较宽,瘤体不规则,因此判断不能介入栓塞治疗,改行开颅手术成功夹闭这些动脉瘤。在手术中通过高倍显微镜仔细观察动脉瘤的形态瘤颈宽窄及与周围分支关系,分别予以各种不同角度投照,再与术前CTA及DSA进行对比,寻找这些动脉瘤的特征。结果 6例均发现动脉瘤囊壁与相邻分支紧密相依或者粘连,并且动脉瘤壁对动脉分支压迫使之形成与瘤壁外形相似弧形走形,甚至分支动脉与瘤壁存在"分节段粘连";4例前交通动脉均发现不同程度变异。动脉瘤成功夹闭后,发现形态基本属于"标准"囊状,可以栓塞。结论动脉瘤周围血管正常解剖变异,动脉瘤壁的压迫或者分支动脉不完全粘连,容易出现造影变形,仔细观察或者动脉瘤囊腔内造影可以区别。

Intracranial aneurysm misdiagnosed to miss the change of interventional therapy by angiography

Objective To investigate whether intracranial aneurysm missed the change of interventional therapy by the judgement of cerebral angiography can be treated by embolization.Method 6 patients who diagnosed to cannot be treated by interventional embolization due to irregular widenecked aneurysms which cannot be distinguished from branches by cerebral angiography accepted craniotomy for clipping the aneurysms.The operations succeeded.Shapes of the aneurysms,wideness of the aneurysm necks and relations with peripheral branches were carefully observed by powerful microscope and photographed from different angles during the operations.Characteristics of the aneurysms were studied by comparing the photoes with preoperative CTA and DSA.Results Walls of the 6 aneurysms tightly clung to or adhered to the peripheral branches and pressed the arterial branches into arcs similar to the aneurysm walls in shape.Furthermore,arterial branches and aneurysm walls even suffered from segmental adhesion.In 4 patients,abnormalities of communicating arteries to varying degrees were found.After successful clipping,it was found that the aneurysms could be embolized since they are basically saccular aneurysms.Conclusion Deformations in angiography can be easily caused by normal anatomical variations of peripheral vessels of the aneurysms,aneurysm wall stress or incomplete adhesion of arterial branches.Such deformations can be recognized by careful observation or intracavitary angiography of aneurysm.