联合血管内外神经介入技术治疗急性期破裂颅内动脉瘤

目的　评估联合血管内外神经介入技术治疗急性期破裂颅内动脉瘤 (aneurysm ,AN)的疗效。方法　对 4 0例急性破裂期AN采用电解脱弹簧圈栓塞 ,随后穿刺腰蛛网膜下腔 ,导丝导向的微导管在透视下插管至枕大池 ,2h后注入 10万U尿激酶 (UK)溶解血块并经微导管持续引流血性脑脊液。根据CT复查结果决定是否继续注射UK。结果　AN栓塞及枕大池插管均获成功 ,无技术相关并发症 ,术后 3～ 7d时的CT见所有患者脑池内的出血消失。除 1例有一过性症状性脑血管痉挛 (CVS)外 ,其余患者无症状性CVS、所有患者无AN再出血。结论　联合血管内外神经介入技术既闭塞了AN ,又清除了蛛网膜下腔积血 ,可防止再出血和继发性CVS的发生 ,达到了对因、对症治疗的双重目的。

Combined endovascular and extravascular neurointerventional technique for treatment of acutely ruptured cerebral aneurysms.

Objective To assess the initial clinical effect of combined endovascular and extravascular neurointerventional technique for treatment of acutely ruptured cerebral aneurysms.Methods Forty patients with acutely ruptured aneurysms were embolized with Guglielmi detachable coil (GDC) or Dendron electrically detachable coil (EDC) firstly. Immediately after the embolization, all patients were received lumbar puncture and over-the-wire microcatheters were catheterized into cisterna magna via the spinal subarachnoid space. Urokinase(100,000 IU in 2mL normal saline) was injected into cisterna magna via the microcatheter to dissolve clot 2 hours later. Urokinase injection was repeated according to the CT results. Results All the procedures of aneurysm embolization and catheterization of cisterna magna were successful, no technical complications were found. In all patients, CT scans of the day 3th to day 7th revealed complete disappearance of clot in basal cistern. One patient experienced transient sympotomatic cerebral vasospasm without permanent neurologic deficit. The other 39 patients didn't manifest symptomatic cerebral vasospasm. No aneurysmal rebleeding was detected. Conclusions Combined endovascular and extravascular neurointerventional technique can obliterate acutely ruptured cerebral aneurysms and remove the clot of basal cistern. It can prevent aneurysm rebleeding and cerebral vasospasm. Therefore it is a minimally invasive, safe and reasonable method for treatment of acutely ruptured cerebral aneurysms.