目的探讨颅内多发宽颈动脉瘤的手术方法、支架选择及围手术期处理。方法支架辅助弹簧圈栓塞17例多发宽颈动脉瘤患者，共34个动脉瘤，与同期采用开颅夹闭术18例多发动脉瘤患者，共夹闭36个动脉瘤，平均住院日、瘤颈残余率及术中、术后并发症对比。结果全部动脉瘤均致密或近致密栓塞，与采用夹闭术患者瘤颈残余率无明显差别。术中及术后并发症少于开颅夹闭患者，平均住院日低于开颅夹闭患者。结论支架辅助弹簧圈栓塞动脉瘤是治疗颅内多发宽颈动脉瘤的一种安全有效的方法，较开颅动脉瘤夹闭术，可减轻手术创伤，降低并发症的发生，缩短住院时间。
Abstract
Objective To study the surgery of the multiple intracranial wide-necked aneurysms, stent selection and perioperative management. Methods Stent assisted coil embolization was performed in 17 patients with multiple wide neck aneurysm, including a total of 34 aneurysms. Average length of stay, neck residual rate and intraoperative and postoperative complications were compared with these in the same period 18 patients with multiple aneurysms, of which 36 were clipped. Results All aneurysms were densely or almost densely embolized, with no significant difference in aneurysm neck residual rate from clipping surgery patients. Intraoperative and postoperative complications, and average length of stay were less than in craniotomy clipping patients. Conclusion Sent-assisted coil embolization of aneurysms is a safe and effective method for the treatment of multiple intracranial wide-necked aneurysms, which reduces surgical trauma and complications, and shortens hospital stay
关键词
颅内动脉瘤 /
多发 /
宽颈 /
支架 /
血管内治疗 /
微弹簧圈
Key words
aneurysms /
multiple /
wide-necked /
stent-assist /
endovascular treatment /
microcoils
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参考文献
[1] Qureshi A,Suarez J I,Parekh P D,et al.Risk factors for multiple intracranial aneurysms[J]. Neurosurgery,1998,43(1):22-26.
[2] Lee L S,Huang S.Aneurysmal subarachnoid hemorrhage in Taiwan[J].Neurol Med Chir(Tokyo),1998, 38(Suppl):122-123.
[3] ellamushi H E,Grieve.T P.et al.Risk factor for the formation of multiple intracranial aneurysms. J Neurosurg.2001.94(5):728-732
[4] Molyneux A J, Kerr RS, Yu L M, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2 143 patients with ruptured intracranial aneurysms: a randomized comparison of effects on survival, dependency, seizures, rebleeding, subgroups,and aneurysm occlusion [J]. Lancet, 2005, 366: 809-917.
[5] Kis B, Weber W, Berlit P. Elective treatment of saccular and broad-necked intracranial aneurysms using a closed-cell nitinol stent (Leo) [J]. Neurosurgery, 2006, 58(3): 443-450.
[6] Wajnberg E, de Souza J M, Marchiori E, et al . Single-center experience with the Neuroform stent for endovascular treatment of wide-necked intracranial aneurysms [J]. Surg Neurol, 2009, 72(6): 612-619.
[7] Biondi A, Janardhan V, Katz J M, et al . Neuroform stent-assisted coil embolization of wide-neck intracranial aneury-sms: strategies in stent deployment and midterm follow-up [J]. Neurosurgery, 2007, 61(3): 460-469.
[8] Broadbent L P, Moran C J, Cross D T, et al. Management of neuroform stent dislodgement and misplacement [J]. Am J Neuroradiol, 2003, 24(9): 1819-1822.
[9] 宋朝理,庄进学.LEO 支架辅助弹簧圈栓塞治疗后交通动脉宽颈动脉瘤 [J].中国微侵袭神经外科杂志,2011,4(16):153-154.
[10] Tahtinen O I, Vanninen R L, Manninen H I, et al. Wide-necked intracranial aneurysms: treatment with stent-assisted coil embolization during acute (<72 hours) subara-chnoid hemorrhage-experience in 61 consecutive patients[J]. Radiology, 2009, 253(1): 199-208
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