颅内多发动脉瘤的微创治疗(1)
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【摘要】 目的 探讨颅内多发动脉瘤的临床特点和手术方法的选择。 方法 回顾性分析我科17例颅内多发动脉瘤应用微创治疗的临床资料，共36个动脉瘤的治疗效果(其中一期血管内栓塞12例患者，25个动脉瘤；一期微创手术夹闭3例患者，6个动脉瘤；二期手术2例，5个动脉瘤)。结果 恢复优良13例，轻残2例，重残1例，死亡1例。术后随访(2年)DSA显示血管内栓塞者有2枚动脉瘤复发。 结论 应用血管内栓塞和微创手术夹闭动脉瘤治疗颅内多发动脉瘤是安全可靠的，两者应相互补充，并尽可能一期处理动脉瘤。
【关键词】
颅内多发动脉瘤； 血管内栓塞；微创手术；预后
Minimally invasive treatment for multiple intracranial aneurysms
ZHANG Jingquan， LI Jinsong， HU Wei， et al.Department of Neurosurgery, People,s Hospital of Meizhou City, Guangdong Province,Meizhou 514031,China
【Abstract】 Objective
To explore the clinical characteristics and choices of operative techniques of multiple intracranial aneurysms. Methods The clinical and imaging data of 17 patients were analyzed retrospectively.36 intracranial aneurysms were in 17 patients, 25 intracranial aneurysms of 12 patients were treated by endovascular embolization with onestage.6 intracranial aneurysms of 3 patients were treated by microsurgical clipping with onestage.5 intracranial aneurysms of 2 patients were treated by microsurgical clipping with twostage. Results 13 patients were recovered well, mild disabilities were in 2 patients and severe disability was 1 patient,1 patient died. DSA during followup in 2 years showed 2 intracranial aneurysms recurrenced in patients with endovascular embolization. Conclusion Microsurgery clipping and endovascular embolization of multiple intracranial aneurysms is safe and reliable, microsurgery clipping and embolotherapy should complement each other, it is possible to treat all intracranial aneurysms in onestage.
【Key words】
Multiple intracranial aneurysms; Endovascular embolization; Minimally invasive surgery; Outcome
作者单位：514031广东省梅州市人民医院神经外科(张敬泉 李劲松 胡威 刘光普 温茂昌 罗妙泉)；华中科技大学同济医学院附属同济医院神经外科(陈坚)
颅内两个或两个以上动脉瘤同时存在者称为颅内多发动脉瘤，无论其诊断或治疗都要难于单发动脉瘤[1]。随着数字减影血管造影技术(Digital Subtraction Angiography DSA)、CT血管造影技术(CT Angiography CTA)和磁共振血管造影技术(MR Angiography MRA)的普及和发展，颅内多发动脉瘤的确诊率和治疗率不断提高。现将我院自2006年9月至2011年9月收治的17例颅内多发动脉瘤患者的诊疗资料报告如下。
1 资料与方法
1.1 一般资料 本组资料共17例，其中男7例，女10例，男∶女为1∶1.4；年龄34～76岁，平均48.6岁。以自发性蛛网膜下腔出血(3AH)为首发症状者14例，占82.4%；脑内出血者2例，占11.7%；动眼神经麻痹者1例，占5.9%；其中已破裂动脉瘤19个，未破裂动脉瘤17个。入院时HuntHess分级：Ⅰ级 9例；Ⅱ级4例；Ⅲ级2例；Ⅳ～Ⅴ级2例 ......
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