多发性颅内动脉瘤的治疗

目的 比较显微外科与血管内治疗对多发性颅内动脉瘤（MIA）的治疗效果和并发症发生率的差别。方法 回顾分析20例MIA（共46个动脉瘤），根据MIA所在部位的区域分级标准，Ⅰ级8例（占40%），Ⅱ级10例（占50%），Ⅲ级2（占10%）。级别越高者，多倾向于选择血管内治疗。结果 显微外科手术组8例，共19个动脉瘤，18个镜下全部夹闭、1个没发现未夹闭。血管内治疗组8例，共17个动脉瘤，14个100%闭塞、1个90%以上闭塞、2个因动脉瘤小导管不能到位未治。颅内外血管搭桥加颈内动脉闭塞2例。未治2例。结论 MIA所在部位的区域分级有助于治疗方法的选择，对MIA多倾于血管内治疗，必要时可2种方法联合应用。

Treatment of multiple intracranial aneurysm

Objective　To study the results of embolization with MDS or GDC coils in patients with multiple intracranial aneurysms (MIA).　Methods　We retrospectively studied 20 patients with MIA (46 aneurysms). According to our standard of zone classification, 8 patients belonged to grade Ⅰ (40%), 10 grade Ⅱ (50%), 2 grade Ⅲ (10%). MDS or GDC embolization was used for the treatment of high grade patients.　Results　In microsurgery group (8 patients), 18 aneurysms were eliminated and one untreated.In endovascular group (8 patients) 14 aneurysms were occluded, one was almost occluded (>90%), and 2 were untreated because of their small size. In EC-IC bypass + balloon occlusion of the internal carotid artery (2 patients), complete occlusion was achieved in 2 giant aneurysms, and 2 aneurysms were untreated.　Conclusions　Zone classification of MIA is helpful to select, treatment. We frefer to endovascular treatment for MIA or combined microsurgical and endovascular approaches if necessary.