[1]张振海　沈春森　吴中学　杨新健　穆士卿.颅内巨大动脉瘤的血管内治疗分析[J].中国临床神经外科杂志,2015,(08):469-472.[doi:10.13798/j.issn.1009-153X.2015.08.008]
　ZHANG Zhen-hai,WU Zhong-xue,MU Shi-qing,et al.Endovascular treatment of giant intracranial aneurysms[J].,2015,(08):469-472.[doi:10.13798/j.issn.1009-153X.2015.08.008]
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颅内巨大动脉瘤的血管内治疗分析()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2015年08期
页码:
469-472
栏目:
论著
出版日期:
2015-08-25

文章信息/Info

Title:
Endovascular treatment of giant intracranial aneurysms
文章编号:
1009-153X（2015）08-0469-04
作者:
张振海　沈春森　吴中学　杨新健　穆士卿
100700 北京，北京军区总医院附属八一脑科医院神经外科（张振海、沈春森）；
100500 北京，北京天坛医院神经介入科（吴中学、杨新健、穆士卿）
Author(s):
ZHANG Zhen-hai1;  WU Zhong-xue2;  MU Shi-qing2;  YANG xin-jiang2;  XU Ru-xiang1;  SHEN Chun-sen1.
1. Department of Neurosurgery, Affiliated Bayi Brain Hospital, General Hospital, Beijing Command, PLA, Beijing 100700, China；
2. Department of Neurological intervention, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100500, China.
关键词:
颅内巨大动脉瘤; 血管内治疗; 预后; 影响因素
Keywords:
Giant intracranial aneurysm;  Endovascular treatment;  Follow-Up
分类号:
R 743.9; R 815.2
DOI:
10.13798/j.issn.1009-153X.2015.08.008
文献标志码:
A
摘要:
目的 探讨血管内治疗颅内巨大动脉瘤的安全性和有效性。方法 回顾性分析连续收治的74例颅内巨大动脉瘤患者的临床资料，其中采用血管内栓塞治疗57例，保守治疗17例。采用Logistic回归分析检验预后影响因素。结果 17例保守治疗患者随访4~71个月，平均（30.7±7.7）个月，死亡4例，症状加重6例、无变化6例、改善1例。57例血管内治疗患者中，术后即刻造影显示完全栓塞38例，次全栓塞6例，部分栓塞13例；28例影像随访3~63个月，平均（11.7±15.2）个月，复发10例（35.7%）；51例临床随访4~71个月，平均（30.7±17.7）个月，42例（73.7%）预后良好（改良Rankin量表评分0~1分）。年龄>60岁、动脉瘤位于后循环和保守治疗与不良预后显著相关（P<0.05）。>结论 对于年龄>60岁以及动脉瘤位于后循环的颅内巨大动脉瘤患者，治疗应慎重；血管内治疗颅内巨大动脉瘤复发率较高。
Abstract:
Objective To explore the safety of endovascular treatment of giant intracranial aneurysms (GIAs) and its effects. Method A retrospective analysis of clinical data of 74 patients with GIAs, of whom 57 were treated by endovascular embolization and 17 were treated conservatively, was made. Of 68 patients who were followed up, 17 who were conservatively treated were followed up from 1 to 17 months [mean, (31.9±22.6) months] and 51 who were treated by endovascular embolization were followed up from 4 to 71 months [mean, (30.7±17.1) months]. Results Of 17 patients who were conservatively treated, 1 had improved symptoms, 6 unchanged symptoms, 6 deteriorated symptoms and 4 died. Of 57 patients treated by endovascular embolization, 38 received total embolization of GIAs, 6 subtotal and 13 part. Of these 57 patients, 42 were recovered well, 4 disabled and 7 died. Of 28 patients who were treated by endovascular embolization followed up by imaging from 3 to 63 months, 10 (35.7%) had recurrence of GIAs and 18 not. Conclusion The curative effect of endovascular embolization on GIAs is good, but the rate of recurrence of GIAs treated by endovascular embolization is relatively higher.

参考文献/References:

[1] Nanda A, Sonig A, Banerjee AD, et al. Microsurgical mana- gement of giant intracranial aneurysm: a single surgeon experience from louisiana state university, Shreveport [J]. World Neurosurg, 2012, S1878-8750.
[2] Ha SW, Jang SJ. Clinical analysis of giant intracranial aneu- rysms with endovascular embolization [J]. J Cerebrovasc Endovasc Neurosurg, 2012, 14(1): 22-28.
[3] Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms [J]. Stroke, 2001, 32(9): 1998-2004.
[4] Murayama Y, Nien YL, Duckwiler G, et al. Guglielmi deta- chable coil embolization of cerebral aneurysms: 11 years’ experience [J]. J Neurosurg, 2003, 98(5): 959-966.
[5] Choi IS, David C. Giant intracranial aneurysms: development, clinical presentationand treatment [J]. Eur J Radiol, 2003, 46: 178-194.
[6] International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinicaloutcome, and risks of surgical and endovas- cular treatment [J]. Lancet, 2003, 362: 103-110.
[7] Lawton MT, Spetzler RF. Surgical management of giant intracranialaneurysms: experience with 171 patients[J]. Clin Neurosurg, 1995, 42: 245-266.
[8] Sundt TM. Surgical techniques for saccular and giant intra- cranial aneurysms [M]. Baltimore: Williams & Wilkins, 1990. 7-56.
[9] Sluzewski M, Menovsky T, van Rooij WJ, et al. Coiling of very large orgiant cerebral aneurysms: long-term clinical and serial angiographic results [J]. Am J Neuroradiol, 2003, 24: 257-262.
[10] Jahromi BS, Mocco J, Bang JA, et al. Clinical and angiogra- phic outcome after endovascular management of giant intra- cranial aneurysms [J]. Neurosurgery, 2008, 63: 662-675.
[11] Dumont TM, Levy EI, Siddiqui AH, et al. Endovascular treatment of giant intracranial aneurysms: a work in progress [J]. World Neurosurg, 2014, 81(5-6): 671-675.
[12] Tim ED, Nicole MD, Steven DC, et al. Predictors of clinical and angiographic outcome after surgical or endovascular therapy of very large and giant intracranial aneurysms [J]. Neurosurgery, 2011, 68: 903-915.
[13] Jung YJ, Kim MS, Choi BY, et al. Fusiform aneurysm on the basilar artery trunk treated with intra-aneurysmal emboli- zation with parent vessel occlusion after complete preopera- tive occlusion test [J]. J Korean Neurosurg Soc, 2013, 53(4): 235-240.
[14] Zhang Z, Lv X, Wu Z, et al. Clinical and angiographic out- come of endovascular and conservative treatment for giant cavernous carotid artery aneurysms [J]. Interv Neuroradiol, 2014, 20(1): 29-36.

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通讯作者：吴中学，E-mail：gfzzh@126.com
更新日期/Last Update: 2016-08-25