破裂性微小动脉瘤的治疗

目的探讨破裂性微小动脉瘤的治疗策略。方法回顾性分析162例微小动脉瘤(≤4mm)的临床资料,采用显微外科手术治疗(简称显外组)85例,其中动脉瘤夹闭术79例,动脉瘤肌肉包裹术6例;采用血管内栓塞治疗(简称介入组)77例,其中单纯弹簧圈栓塞67例,支架辅助7例,球囊辅助3例。同时行开颅血肿清除、减压术5例。并对所有病例进行术后1年改良RANKIN量表(mRS)评估和分析预后。结果显外组:术后2～3周复查DSA42例,其中瘤颈残留2例,余43例未行DSA复查;介入组:完全栓塞50例,次全栓塞20例,部分栓塞7例。显外组和介入组围手术期并发症分别为:出血性事件2例和6例,缺血性事件7例和2例,颅内感染3例和1例,癫疒间3例和0例。术后1年mRS量表评分,显外组和介入组的预后良好率(mRS0～2分)分别是89.6%和92.9%(P0.05),本组所有病人入院时Hunt-Hess分级与1年mRS生活质量评分相关(rs=0.404,P0.001)。结论血管内栓塞治疗是破裂性微小动脉瘤安全而有效的治疗方法;与显微外科手术相比,术后1年临床随访结果相似。

The surgical treatment of ruptured microaneurysms

Objective To evaluate the clinical treatment strategies of ruptured microaneurysms.Methods Clinical data of 162 patients with ruptured intracranial microaneurysms were analyzed retrospectively.Microsurgical treatment was performed in 85 patients（surgical group）including aneurysm clipping in 79 patients and wrapping of aneurysm in 6.Endovascular embolization was performed in 77 patients（endovascular group）including simple detachable coil embolization in 67 patients,stent-assisted in 7 and balloon-assisted in 3.Five patients underwent hematoma evacuation by craniotomy and decompression simultaneously.The prognosis of all the patients were assessed and analyzed by modified Rankin Scale（mRS）1 year postoperatively.Results In surgical group,42 patients were reexamined by DSA 2 to 3 weeks after the surgery while 43 patients received no DSA review postoperatively,and residual neck was seen in 2.In endovascular group,complete embolization was achieved in 50 cases,subtotal embolization in 20 and partial embolization in 7.Perioperative complications in the surgical group and endovascular group were hemorrhagic events in 2 cases and 6,ischemic events in 7 and 2,intracranial infection in 3 and 1,and epilepsy in 3 and 0,respectively.According to mRS 1 year postoperatively,the good prognosis rates（mRS 0-2）in surgical group and endovascular group were 89.6% and 92.9%,respectively（P〉0.05）.There was a significant correlation between Hunt-Hess score on admission and mRS score 1 year postoperatively（rs = 0.404,P〈0.001）.Conclusions Endovascular therapy is a safe and effective treatment for ruptured microaneurysms and the 1 year follow-up results are similar to those of microsurgery.