【作者】 黄庆锋； 孙树清； 沈剑虹； 杨柳； 龚佩佩； 陈建； 卢小健；

【Author】 HUANG Qingfeng;SUN Shuqing;SHEN Jianhong;YANG Liu;GONG Peipei;CHEN Jian;LU Xiaojian;Department of Neurosurgery,Affiliated Hospital of Nantong University;

【机构】 南通大学附属医院神经外科；

【摘要】 目的:探讨椎动脉夹层动脉瘤的个体化血管内治疗的可行性及疗效分析。方法:回顾性分析18例椎动脉夹层动脉瘤的临床资料,分析不同情况下血管内治疗夹层动脉瘤需考虑的个体化特点,以及对不同疗效的分析。根据临床症状、椎动脉优势供血及影像学分型,采用单纯支架置入术(SO)、支架辅助弹簧圈栓塞术(SAC)或载瘤动脉闭塞术(PAO)治疗。结果:18例中蛛网膜下腔出血12例,第四脑室出血2例,脑干梗死1例,后循环TIA 1例,反复头痛头晕2例。有3例CTA检查阴性,经DSA确诊。行血管内治疗17例,1例放弃血管内治疗。采用SAC治疗4例,PAO治疗8例,SO治疗5例;无术中动脉瘤破裂出血,术后随访时间为3～24个月,均无新发神经功能缺损症状;其中15例行数字减影血管造影复查,13例治愈,2例复发。结论:椎动脉夹层动脉瘤以后颅窝蛛网膜下腔出血起病多见,头痛以枕项部剧痛为主,确诊需DSA,治疗方式以血管内治疗为首选,根据临床症状、椎动脉供血优势选择个体化的血管内治疗策略治疗椎动脉夹层动脉瘤安全、有效。更多还原

【Abstract】 Objective:To investigate the feasibility and efficacy of individualized endovascular treatment for vertebral artery dissecting aneurysms.Methods:The clinical data of 18 cases of vertebral artery dissecting aneurysms were analyzed retrospectively.The individual characteristics that should be considered in endovascular treatment of dissecting aneurysms under different conditions were analyzed,and the different curative effects were analyzed.Based on clinical symptoms,superior vertebral blood supply,and imaging type,patients were treated with simple stent implantation(SO),stent-assisted coil embolization(SAC),or parent artery occlusion(PAO).Results:Among the 18 cases,there were 12 cases of subarachnoid hemorrhage,2 cases of fourth ventricle hemorrhage,1 case of brainstem infarction,1 case of posterior circulation TIA,and 2 cases of recurrent headache and dizziness.CTA of 3 patients were negative and confirmed by DSA.Endovascular treatment was performed in 17 cases,and endovascular treatment was abandoned in 1 case.4 cases were treated with SAC,8 with PAO and 5 with SO.There was no intraoperative aneurysm rupture and hemorrhage,and the postoperative follow-up time was 3 ～ 24 months.Among them,15 patients underwent digital subtraction angiography,13 patients were cured and 2 patients relapsed.Conclusion:Vertebral artery dissecting aneurysms are mostly caused by posterior fossa subarachnoid hemorrhage,and headache is mainly caused by severe pain in the occipital segment.DSA is required for diagnosis.Endovascular therapy is the first choice for treatment.更多还原