【摘要】 目的　描述颅内巨大蛇形动脉瘤 (giantserpentineaneurysm ,GSA)CT、MRI和DSA的典型特征 ,讨论血管内治疗方法的有效性。方法　回顾性研究过去 2年中收治的 4例GSA ,4例行DSA和CT检查 ,1例行MRI和MRA检查 ,2例接受载瘤动脉可脱球囊栓塞和栓塞前颅内 颅外动脉搭桥 ,结合文献进行讨论。结果　 4例GSA临床表现为颅内高压、出血和占位效应。CT显示规则、不规则的球形或梨形巨大不均质高密度占位 ,可见周边蛋壳样钙化、占位效应、周围脑组织水肿 ,增强扫描显示瘤壁略强化 ,相对低密度区均一强化 ,呈靶征。MRI显示梨形或分叶状占位 ,内含不同时期的血栓、流空信号 ,周围脑组织水肿。MRA显示蛇形血管通道。DSA显示蛇形血管通道、流入口、流出口、正常远端动脉。 2例血管内治疗辅以颅内 颅外搭桥 ,随访 12～ 2 6个月 ,症状体征完全消失。结论　GSA具有特有的CT、MRI和DSA表现特征 ,构成颅内动脉瘤的亚型 ,预后差 ,必须积极治疗。血管内治疗结合颅外 颅内动脉搭桥手术是安全有效的治疗措施更多还原

【Abstract】 Objective To describe the typical CT, MRI and DSA features of intracranial giant serpentine aneurysm (GSA) and discuss the efficacy of it′s the endovascular treatment. Methods Retrograde study of 4 cases of GSA admitted and treated at the center of the present study over the last 2 years was conducted. The literature before June 1988 was reviewed. Results The findings of CT and MRI scans of GSA resembled those of intracranial neoplasms. Cerebral angiography remained the golden diagnostic criteria for GSA. Two of cases in the present study were treated with detachable balloon occlusion of the parent artery and pre occlusion EC IC bypass because of insufficient cross filling through the Willis circle found on the cross filling symmetry test. The symptoms and signs of the two patients disappeared on 1 2 year follow up and follow up CT study showed no obvious change in aneurysmal size. Conclusion The GSA is different from the intracranial giant sacular or fusiform aneurysms because it has distinctive features on CT, MRI and DSA studies. GSA constitutes a subgroup of the intracranial giant aneurysms. The natural history of GSA is poor so it is necessary to give GSA aggressive management. The endovascular occlusion of the parent artery with functional EC IC bypass is safe and effective.更多还原