未破裂颅内动脉瘤的临床特点及血管内栓塞治疗

目的总结未破裂颅内动脉瘤的临床特点以及用电解可脱性弹簧圈(GDC)血管内栓塞治疗的技术要点、并发症及其防治经验,并客观评价其必要性、安全性及治疗效果。方法采用电解可脱性弹簧圈对46例未破裂颅内动脉瘤患者进行动脉瘤囊内栓塞。结果成功栓塞46个动脉瘤,其中100%闭塞42个,95%闭塞3个,90%闭塞1个,全组无死亡。术中并发脑血管痉挛2例,弹簧圈末端逸出1例,1例复发者经二次填充GDC栓塞而治愈。术后随访12~72个月,临床症状均消失,20例有颅神经压迫症状者18例完全恢复正常,另2例为永久性动眼神经不全麻痹,全组术后均无破裂出血。结论对未破裂颅内动脉瘤早期诊断和早期治疗是必要的,采用电解可脱性弹簧圈进行动脉瘤囊内栓塞的方法安全实用、疗效可靠。

Clinical characteristics and endovascular embolization therapy of unruptured intracranial aneurysms

Objective To summarize the clinical characteristics of unruptured intracranial aneurysms, the technical points, complications, prevention and treatment experience of Guglielmi detachable microcoil (GDC) endovascular embolization, and to evaluate objectively the necessity, safety and outcomes of this method. MethodsAneurysmal intracapsular embolization with GDC was applied in 46 cases of unruptured aneurysms.Results A total of 46 cases of aneurysms were successfully embolized, including 42 cases of 100% occlusion, 3 cases of 95% occlusion, 1 case of 90% occlusion, and no dead case. The complication of cerebral vasospasm during operation occurred in 2 cases, 1 case was affected by microcoil teminal escape, and 1 recurrent case was cured by secondary complementary GDC embolization. The clinical symptoms all disappeared postoperation with follow-up of 12 to 72 months, in 20 cases with cranial nerve compression symptoms, 18 cases got complete recovery, 2 cases suffered permanent oculomotor nerve paresis, and no ruptured bleeding postoperation.Conclusion Early diagnosis and early treatment for unruptured intracranial aneurysms is necessary. Aneurysmal intracapsular embolization with GDC is a safe and practical method with reliable curative effects.