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目的:探讨颅内动脉瘤诊断方法的选择以及开颅直接手术或采取血管内介入手术的取向等问题。方法: 2004年1月至2006年12月收治190例颅内动脉瘤患者中男63例、女127例,年龄25～79岁、平均44.7岁。诊断:所有病人术前均行颅脑CT检查、MRI检查37例、MRA31例、通过CTA及3D-CTA确诊134例;DSA/3D-DSA确诊142例;治疗:直接手术96例,其中因血管内手术失败而开颅4例;采用血管内介入治疗92例,其中ONYX胶栓塞2例,其余均采用GDC栓塞手术。方法:死亡9例,其中2例再出血、3例死于严重的血管痉挛,肺炎等并发症死亡4例,其余病人均痊愈出院。结论:CT为蛛网膜下腔出血的首诊选择,MRA可作为无出血史病人的检查,但不宜以此直接手术;CTA/3D-CTA在相当病人中可以确定动脉瘤的大小、部位、供血动脉及破裂点,并依此直接手术;DSA尤其3D- DSA对复杂性的动脉瘤的血供情况可清晰提示并指导手术。血管内栓塞治疗和直接开颅夹闭手术各有优点,我们主张急性期脑肿胀病人应首先尝试行急诊介入治疗,但血管痉挛明显的病人应果断早期手术,其中多发性动脉瘤的重点是判断责任动脉瘤。
Objective: To discuss the selection of diagnostic methods of intracranial aneurysms and the problems of direct craniotomy or orientation of endovascular interventional surgery. Methods: From January 2004 to December 2006, there were 63 males and 127 females with 190 cases of intracranial aneurysms, aged from 25 to 79 years, with an average of 44.7 years. Diagnosis: All patients underwent craniocerebral CT examination, MRI examination in 37 cases, MRA in 31 cases, confirmed by CTA and 3D-CTA in 134 cases; DSA / 3D-DSA confirmed 142 cases; treatment: direct surgery in 96 cases, 4 cases of intracranial failure and intracranial surgery; 92 cases of endovascular interventional therapy, including 2 cases of ONYX plastic plug, the rest were treated with GDC embolization. Methods: Nine died, of which two were rebleeding, three died of severe vasospasm, pneumonia and other complications of death in 4 cases, the remaining patients were cured and discharged. Conclusion: CT is the first choice of subarachnoid hemorrhage, MRA can be used as a test for patients without history of bleeding, but it is not suitable for direct surgery. CTA / 3D-CTA can determine the size, location, Arteries and rupture points, and direct surgery accordingly; DSA, especially 3D-DSA for the complexity of aneurysm blood supply can be clearly prompted and guide the operation. Endovascular embolization and direct craniotomy have advantages, we advocate acute brain swelling patients should first try emergency intervention, but the obvious vasospasm patients should be decisive early surgery, in which the focus of multiple aneurysms is to judge Liability aneurysm.