颅内多发动脉瘤的诊断与治疗策略.pdfVIP

临床研究 颅内多发动脉瘤的诊断与治疗策略颅内多发动脉瘤的诊断与治疗策略 王 刚，冯文峰，张国忠，李明洲，何小艳，彭四维，漆松涛 南方医科大学南方医院神经外科，广东 广州 510515 摘要：目的探讨颅内多发动脉瘤的影像学特点、诊断与治疗策略。方法 回顾性分析96 例共234 枚颅内动脉瘤的临床及影像学 特点，结合头颅CT 提示的蛛网膜下腔出血模式及DSA 结果判定责任动脉瘤。对责任动脉瘤均采取显微夹闭术或者血管内介 入栓塞术积极治疗，对于非责任动脉瘤予以选择性治疗。结果 96 例多发动脉瘤行栓塞治疗56 例，夹闭治疗28 例，未治疗12 例。44 例一期治疗所有动脉瘤，4 例分期处理所有动脉瘤，36 例仅治疗责任动脉瘤。接受治疗的84例患者，出院时预后格拉斯 哥预后评分（GOS）评分5分62例，4 分12例，3分8例，1分2 例。术后6个月DSA 随访30例，1例复发接受再治疗，余29 例治疗效 果稳定。结论 颅内多发动脉瘤应在诊断全面的基础上，正确判断责任动脉瘤并积极治疗，对于非责任病灶需要综合评估出血 风险，采取个体化治疗措施，尽量一期治疗所有动脉瘤，减少再出血风险。 关键词：脑疾病；多发动脉瘤 Diagnosis and treatment of multiple intracranial aneurysms WANG Gang, FENG Wenfeng, ZHANG Guozhong, LI Weiguang, LI Mingzhou, HE Xiaoyan, PENG Siwei, QI Songtao Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China Abstract: Objective To explore the diagnosis and treatment strategy of multiple intracranial aneurysms (MIA). Methods We retrospectively analyzed 96 patients with MIA (234 aneurysms). The rupture site was determined on the basis of computed tomographic and angiographic findings, and the supposed ruptured aneurysm was treated with coiling OR clipping. All the patients records were reviewed including all computed tomographic scans and angiograms. Results Twelve patients received conservative treatment, 56 patients were treated by endovascular embolization, and 28 patients received clipping; 44 patients received one-stage treatment, and 4 patients needed a second therapy. In 36 patients, only the ruptured aneurysm was eliminated. The clinical outcomes of these 84 patients evaluated by Glasgow Outcome Scale grades were: absence of deficits in 62 patients, minor deficits in 12 patients, major deficit in 8 patients; death occurred in 2 cases. Thirty patients were available for a 6-month follow-up with DSA, which revealed stable occlusion of the aneurysms in 29 patients and the need of a retreatment