威利斯环外未破裂动脉瘤的管道

Q4 Medicine

中华神经外科杂志 Pub Date : 2019-09-28 DOI:10.3760/CMA.J.ISSN.1001-2346.2019.09.004

Chao Ma, P. Yan, Yupeng Zhang, F. Liang, Shikai Liang, Chuhan Jiang

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Modified Ranking scale (mRS) was used to comprehensively evaluate the patients after surgery. Patients were followed up radiographically at 6, 12 and 24 months post surgery, and the O' kelly-Marotta (OKM) grading was used to evaluate aneurysm embolization. \n \n \nResults \nA total of 17 PEDs were implanted in 14 patients, all of which were successful. Immediate postoperative cerebral infarction was observed in 2 patients (1 case of ACoA dissecting aneurysm and 1 case of MCA M1 dissecting aneurysm), and the symptoms were improved after medication. One patient with MCA M1 dissecting aneurysm ruptured at 9 h post surgery and died after treatment. At discharge, there were 11 patients with good postoperative neurological function (mRS: 0-1) and 2 patientswith neurological dysfunction (mRS: 3). There were 12 patients who obtained follow-up post operation with an average follow-up duration of 3.0-6.0 (4.7±1.4) months. At last follow-up, the mRS scores were 0 in 11 cases and 1 in 1 case. 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引用次数: 0

摘要

目的探讨管道栓塞装置（PED）治疗Willis环外未破裂动脉瘤的疗效及并发症。方法回顾性分析2016年1月至2019年1月在首都医科大学北京天坛医院介入神经外科和北京清华长庚医院神经外科接受PED治疗的14例Willis环外未破裂动脉瘤患者的临床资料。其中10例接受了PED植入术，4例接受PED辅助盘绕术。14名患者中的每个病例都有一个动脉瘤。11例为首次治疗，3例为复发性病例。采用改良分级量表（mRS）对术后患者进行综合评价。术后6个月、12个月和24个月对患者进行了放射学随访，并使用O’kelly-Marotta（OKM）分级来评估动脉瘤栓塞。结果14例患者共植入17个PED，均获得成功。2例患者（1例ACoA夹层动脉瘤和1例MCA M1夹层动脉瘤）术后立即发生脑梗死，用药后症状有所改善。1例MCA M1夹层动脉瘤患者在术后9小时破裂，治疗后死亡。出院时，有11名患者术后神经功能良好（mRS:0-1），2名患者神经功能障碍（mRS:3）。术后随访12例，平均随访时间3.0-6.0（4.7±1.4）个月。在最后的随访中，mRS评分11例为0，1例为1。血管造影随访显示，12名患者的12个动脉瘤中有9个完全闭塞，3个有残留的颈部。所有3例复发性动脉瘤患者在术后6个月的随访中均显示完全栓塞。结论PED治疗Willis环外未破裂动脉瘤是一种安全有效的治疗方法，对复发性Willis环以外未破裂的动脉瘤有良好的治疗效果。然而，它可能与MCA动脉瘤治疗中相对较高的风险有关。关键词：颅内动脉瘤；威利斯圈；远端；管道栓塞装置

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Pipeline for unruptured aneurysms beyond the circle of Willis

Objective To investigate the efficacy and complications of Pipeline embolization device (PED) in the treatment of unruptured aneurysms beyond the circle of Willis. Methods A retrospective study was conducted on the clinical data of 14 patients with unruptured aneurysms beyond the circle of Willis treated with PED at Department of Interventional Neuroradiology, Beijing Tiantan Hospital , Capital Medical University (n=11) and Department of Neurosurgery, Beijing Tsinghua Changgung Hospital (n=3) from January 2016 to January 2019. Among those, 10 cases underwent PED implantation and 4 underwent PED-assisted coiling. Each case among the 14 patients had a single aneurysm. Eleven cases underwent first treatment and 3 were recurrent cases. Modified Ranking scale (mRS) was used to comprehensively evaluate the patients after surgery. Patients were followed up radiographically at 6, 12 and 24 months post surgery, and the O' kelly-Marotta (OKM) grading was used to evaluate aneurysm embolization. Results A total of 17 PEDs were implanted in 14 patients, all of which were successful. Immediate postoperative cerebral infarction was observed in 2 patients (1 case of ACoA dissecting aneurysm and 1 case of MCA M1 dissecting aneurysm), and the symptoms were improved after medication. One patient with MCA M1 dissecting aneurysm ruptured at 9 h post surgery and died after treatment. At discharge, there were 11 patients with good postoperative neurological function (mRS: 0-1) and 2 patientswith neurological dysfunction (mRS: 3). There were 12 patients who obtained follow-up post operation with an average follow-up duration of 3.0-6.0 (4.7±1.4) months. At last follow-up, the mRS scores were 0 in 11 cases and 1 in 1 case. Angiographic follow-up showed that 9 of the 12 aneurysms in the 12 patients were completely occluded and 3 had residual neck. All the 3 patients with recurrent aneurysms revealed complete embolization at 6-month follow-up post operation. Conclusions PED is generally safe and effective in the treatment of unruptured aneurysms beyond the circle of Willis which could have a good therapeutic effect on recurrent unruptured aneurysms beyond the circle of Willis. However, it might be associated with relatively high risk in treatment of MCA aneurysms. Key words: Intracranial aneurysm; Circle of Willis; Distal; Pipeline embolization device

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来源期刊

中华神经外科杂志 Medicine-Surgery

CiteScore

0.10

自引率

0.00%

发文量

10706

期刊介绍： Chinese Journal of Neurosurgery is one of the series of journals organized by the Chinese Medical Association under the supervision of the China Association for Science and Technology. The journal is aimed at neurosurgeons and related researchers, and reports on the leading scientific research results and clinical experience in the field of neurosurgery, as well as the basic theoretical research closely related to neurosurgery.Chinese Journal of Neurosurgery has been included in many famous domestic search organizations, such as China Knowledge Resources Database, China Biomedical Journal Citation Database, Chinese Biomedical Journal Literature Database, China Science Citation Database, China Biomedical Literature Database, China Science and Technology Paper Citation Statistical Analysis Database, and China Science and Technology Journal Full Text Database, Wanfang Data Database of Medical Journals, etc.