颅内真性动脉瘤破裂出血后假性动脉瘤形成及血流动力学研究

目的：探讨颅内动脉瘤破裂出血后在其破口周围形成假性动脉瘤，及其形成机制、早期诊断和治疗的意义。方法：建立兔假性动脉瘤与真性动脉瘤合并假性动脉瘤的动物模型，探讨假性动脉瘤形成的机制，对临床60例自发性蛛网膜下腔出血患者DSA造影影像及电解铂金微弹簧圈（Guglielmi Detachable Coil，GDC）血管内栓塞动脉瘤的情况进行分析。结果：用创伤与显微外科相结合的方法，成功建立假性动脉瘤动物模型，其形成分为动脉瘤破裂出血血肿形成期、假性动脉瘤形成前期、假性动脉瘤形成期及假性动脉瘤增大破裂出血期四个阶段。颅内动脉瘤破裂出血早期行DSA血管造影时可见其影像形态不规则呈哑铃状、双腔、瘤囊顶鼓出小泡等表现，血管内栓塞治疗可见：①GDC只能进入靠近载瘤动脉的瘤腔，并将其栓塞，完全不进入远离载瘤动脉的瘤腔，栓塞后透视下见未充填GDC的瘤腔内有造影剂滞留；②GDC完全填塞靠近载瘤动脉的瘤腔，部分填塞远离载瘤动脉的瘤腔；③GDC将靠近与远离载瘤动脉的两个瘤腔完全填塞。以上3种病变在栓塞后造影见动脉瘤完全闭塞，随访造影见动脉瘤消失。结论：颅内动脉瘤破裂出血后，在其破口周围可以形成假性动脉瘤，其形成与血流动力学改变有关，形成过程分为动脉瘤破裂血肿形成期、假性动脉瘤形成前期、形成期及增大破裂出血期四个阶段。对伴有假性动脉瘤的颅内真性动脉瘤尽早行病因治疗是防止再出血、提高治愈率、降低死残率的关键。

Fundamental and Clinical Research on False Aneurysm Formation After the Rupture of Intracranial Aneurysm

Objective：To investigate the mechanism, early diagnosis and treatment of false aneurysm （FA） formation after rupture of intracranial aneurysm. Methods： Rat model of FA and true aneurysm complicated by FA were established to investigated the mechanism of FA formation. The DSA image and GDC （Guglielmi Detachable Coil） intravascular aneurysm emboligation were analyzed. Results： The process of FA formation could divided into four phases： rupture, hemorrhage and hematoma formation of aneurysm, preformation phase of FA, FA formation, enlargement and rupture of FA. In early phase of rupture and hemorrhage of intracranial aneurysm, irregular images such as dumbbell-like image; double cavity and bud at top of aneurysm sac observed by DSA. ① The proximal aneurysmal lumen, not distal to the feeding arteries could be filled and embolized with GDC. The repeated angiography after the embolization and during follow-up phase showed that there was residual contrast medium in aneurysmal lumen which was not filled by GDC. ② The aneurysmal lumen proximal to feeding arteries were tightly filled with GDC; the lumen distal to the feeding arteries were partly filled with GDC. ③ Both lumen of aneurysm could be filled with GDC. The repeated angiography in last 3 groups after the embolization and during follow-up phase showed that the aneurysm disappeared. Conclusion： FA can form around the ruptured aneurysm, early clipping the neck of aneurysm or endovascular embolization play an important role in preventing secondary hemorrhage and decrease morbidity or mortality rate.