老年患者急性破裂性颅内动脉瘤的早期血管内栓塞治疗-神经外科专业论文.docxVIP

华中科技太掌月济l掌豌老年患者急性破裂性颅内动脉瘤的 华中科技太掌月济l掌豌 老年患者急性破裂性颅内动脉瘤的 早期血管内栓塞治疗 华中科技大学同济医学院附属曲碍口医院 硕士生：谭显西 导师：赵甲山教授 摘 要 目的探讨老年患者急性破裂性颅内动脉瘤早期血管内栓塞治疗的 技术要点及疗效。 方法27例年龄大于65岁的急性破裂性颅内动脉瘤老年患者早期(首 次破裂3天内)采用经股或颈动脉Seldinger’s技术，应用GDCl0、GDCl8、 EDC和MATRIX等电解可脱微弹簧圈进行动脉瘤囊内栓塞。其中1例为 多发动脉瘤。动脉瘰位置：前交通动脉瘤(ACoA)6个，大脑前动脉瘸 (ACAA)2个，大脑中动脉瘤(MCAA)2个，后交通动脉(PCoA)瘤 12个，椎基底动脉(BVA)瘤2个，小脑后下动脉瘤(P1CAA)2个，眼 动脉瘤2个。HessHunt分级：II级9例，III级14例，IV级3例，V级1 例。动脉瘤直径(10mm的24例，10mm的4例。 结果动脉瘤腔完全闭塞的22个，闭塞95％的4个。90％的2个。患 者出院时按格拉斯哥预后评分分级：I级22例，II级2例，III—lv级2例， V级1例。1例椎动脉瘤栓塞后5小时动脉瘤再次破裂出血死亡。3例栓 塞术后并发不同程度的脑梗塞。6例出现脑积水，先后行脑室外引流术及 或脑室腹腔引流术。所有病人栓塞术后均随访0．5．2年。20例血管造影复 查，未见动脉瘤复发，4例摄头颅平片，弹簧圈形状如初。其余信访或电 话随访。无爵出血病人。 华中科^掌月济E掌院结论早期动脉瘤囊内栓塞是治疗老年患者急性破裂性颅内动脉瘸 华中科^掌月济E掌院 结论早期动脉瘤囊内栓塞是治疗老年患者急性破裂性颅内动脉瘸 较理想的方法．可明品降低忠糟残疾程度及死亡率。经股动脉穿刺胃导引 导管困难者，经颈动脉穿刺效果佳，术中保持血压平稳，避免血管过度刺激， 术后继续抗凝治疗，可明显减少梗塞并发症。 【关键词】 颅内动脉瘤： 老年患者； 早期栓塞 毕中科技大掌．『冒i济匮掌院 毕中科技大掌．『冒i济匮掌院 Ⅻ--a：r}业论Jc． Early EndoVascular Treatment ofActual Ruptured Intracranial Aneurysms in Elderly Patients with GDC Postgraduate student：Tan Xian xi Tutor professor：Zhao Jia shan Department of Neurosurgery,Union Hospital ofTong Ji medical college Hua Zhong University of Science and Technology ABSTRACT PURPOSE To study the effect and outcome of early endovascular embolotherapy of actualy ruptured intracranial aneurysms in elderly patients with microcoils． METHOD 27 elderly(65y)patients were treated with microcoils (GDCIO、GDCl8、EDC、MATRIX，et a1)to embolize the aneurysmal sac by carotid and femoral artery approach．1 cases were found to have 2 anuerysms respectively．The aneurysms were located as follows：6 in the anterior communicating artery,2 in A1一A2，2 in M1，12 in the posterior communicating artery,2 in the basilar and vertebrar artery,2 in the PICAA，2 in the carotid·ophthalmic region．9 cases were classified as HessHunt Grade II，14 as Grade III，3 as GradeⅣ，1 as Grade V．The diameters of 24 aneurysms were less tha 10ram，others lager than 10mm． RESULT The sac of 22 anuerysms were completely occluded，and 4 4 华十耳斗技大掌_i百l济E