大脑中动脉分叉部动脉瘤的血管内治疗

目的总结大脑中动脉分叉部动脉瘤的诊断和血管内治疗方法。方法 2010年1月-2011年6月,收治32例大脑中动脉分叉部动脉瘤患者并行血管内治疗。男12例,女20例;年龄35～81岁,平均49.5岁。患者均有突发头痛病史,其中2例有意识障碍伴一侧肢体活动受限;22例有高血压病史。术前Hunt-Hess分级:Ⅰ级10例,Ⅱ级15例,Ⅲ级7例;Fisher分级:Ⅱ级24例,Ⅲ级8例。16例患者应用单微导管弹簧圈栓塞,7例应用双微导管弹簧圈栓塞,4例应用球囊辅助弹簧圈栓塞,4例应用单支架辅助弹簧圈栓塞,1例应用双支架辅助弹簧圈栓塞。结果术后即刻数字减影血管造影检查示,除2例单微导管弹簧圈栓塞者获近乎致密栓塞外,余均获致密栓塞。术中18例蛛网膜下腔广泛出血,行腰大池置管持续引流3～7 d;余14例有少量蛛网膜下腔出血,术后间断腰椎穿刺缓慢释放血性脑脊液。术后1周颅脑CT示蛛网膜下腔出血量明显减少。术后1 d,2例出现局部脑缺血,经尼莫同等药物抗血管痉挛治疗1周后缓解。32例均获随访,随访时间4～17个月。患者无动脉瘤破裂再出血,术后3例一侧肢体瘫痪,1例术后失语,余无并发症及后遗症发生。术后3、6个月及1年复查计算机断层摄影血管造影术示致密栓塞的动脉瘤未再通。结论选择合适的介入治疗方法,大脑中动脉分叉部动脉瘤的血管内治疗是安全、可靠的。

Endovascular treatment of middle cerebral artery bifurcation aneurysms

Objective To summarize the diagnosis and endovascular treatment of middle cerebral artery(MCA) bifurcation aneurysm.Methods Between January 2010 and June 2011,32 patients with MCA bifurcation aneurysm underwent endovascular treatment.There were 12 males and 20 females,aged 49.5 years on average(range,35-81 years).All patients had sudden headache,2 cases had disturbance of consciousness and hemiplegia,and 22 cases had a history of hypertension.Before operation,10 cases were classi ed as Hunt-Hess level I,15 cases as level II,and 7 cases as level III;24 cases were classi ed as Fisher level II and 8 cases as level III.The patients underwent coil embolization using single microcatheter in 16 cases,using double microcatheter in 7 cases,using balloon-assisted in 4 cases,using single stent in 4 cases,and using double stent in 1 case.Results The results of postoperative immediate digital subtraction angiography showed that 30 patients achieved denseffembolization,and 2 patients using single microcatheter achieved approximated denseffembolization.Among them,18 cases su ered extensive subarachnoid hemorrhage,thus lumbar puncture continued drainage was performed for 3-7 days;the other 14 cases had little subarachnoid hemorrhage,lumbar puncture released hemorrhagic cerebrospinal uid discontinuously,and after 1 week,head CT demonstrated that subarachnoid hemorrhage was signi cantly decreased.At 1 day after surgery,2 patients had local cerebral ischemia;after Nimotop and other drugs were used for 1 week,the symptom was alleviative.All 32 patients were followed up 4 to 17 months.No aneurysm rupture and bleed occurred during follow-up;no other complications or sequelae was observed except for 3 cases of hemiparesis and 1 case of aphasia.The computed tomographic angiography examination showed no re-open of denseffembolized aneurysm at 3,6 months,and 1 year after surgery.Conclusion As long as appropriate intervention treatment method is chosen,endovascular treatment of MCA bifurcation aneurysm is safe and effective.