颅内微型动脉瘤诊断和治疗的临床研究

目的探讨颅内微型动脉瘤的临床特征和治疗方法。方法经DSA确诊的颅内微型动脉瘤（直径〈3mm）21例（22枚）中，1例放弃外科治疗；9例行开颅手术．其中动脉瘤夹闭5例，包裹3例（1例电凝动脉瘤后动脉瘤消失），孤立载瘤动脉（颈内动脉）1例；11例行血管内治疗，其中1例小脑上动脉瘤采用NBCA胶栓塞，10例（11枚动脉瘤）采用微弹簧圈栓塞，其中采用瘤颈成型技术6例（支架辅助2例，双导管技术3例，导丝辅助技术1例）。结果行开颅手术的9例中，死亡1例，治愈4例，好转2例，残废2例；术中动脉瘤破裂2例。行血管内治疗手术的11例中，死亡1例，治愈7例，好转1例，残废2例。血管内栓塞术中动脉瘤破裂2例。结论3D—DSA是诊断颅内微型动脉瘤最有价值的方法，手术和栓塞治疗的风险均较高，但采用适当的技术仍可以取得好的效果。

Diagnosis and Treatment of Intracranial Blister-like Aneurysms

Objective To explore the methods to diagnose and treat intracranial blister-like aneurysms. Methods Twenty-two intracranial blister-like aneurysms （less than 3 mm in diameter） were definitely diagnosed as by DSA in 21 patients, of whom, 1 refused surgical treatment, 9 underwent microsurgery and 11 endovascular embolization. Results In 9 patients undergoing microsurgery, 5 aneurysms were clipped, 3 were enwrapped and 1 was treated by clipped the parent artery and aneurysm. In 2 patients undergoing microsurgery, the aneurysms ruptured during the operation. Of 9 patients undergoing the microsurgery, 4 were cured, 2 improved, 2 disabled and 1 died. Of 11 patients with 12 aneurysms undergoing endovascular embolization with NBCA glue （1 patient） and coils （10 patients with 11 aneurysms）, 7 were cured, 1 improved, 2 disabled and 1 died. The aneurysms ruptured during endovascular embolization with coils in 2 patients. Conclusions Three-dimensional DSA is a good method to diagnose the intracranial blister-like aneurysms. The treatment of intracranial blister-like aneurysms by the micresurgery or endovascular embolization is of certain risk, but good outcomes may be obtained in most of the patients with intracranial aneurysms by skillful technique.