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目的探讨大脑中动脉瘤治疗方法的选择和疗效。方法回顾性分析2005年1月至2011年7月间手术夹闭和血管内介入治疗的111例114个大脑中动脉瘤。分析术前分级、动脉瘤大小、部位、治疗结果。结果手术夹闭88例患者90个动脉瘤,术后15 d～48个月(平均12.7个月)造影随访,夹闭动脉瘤89个,瘤颈残留1个,未见复发。血管内介入治疗23例24个动脉瘤。支架辅助栓塞7个,球囊辅助栓塞3个,单纯微弹簧圈栓塞12个,17个动脉瘤术后1～37个月(平均10.6个月)造影随访,5个(29.4%)复发;单纯支架治疗2个(未破裂夹层动脉瘤),术后3个月造影随访,1个动脉瘤消失,1个无变化。Glasgow预后评分5～4分中夹闭72例(81.8%),介入21例(91.3%)。结论窄颈(浆果样)大脑中动脉瘤,手术夹闭和介入栓塞均不易复发。复杂大脑中动脉瘤手术夹闭不易复发,介入栓塞相对容易复发。大脑中动脉瘤合并血肿(血肿量>30 mL),选择手术夹闭动脉瘤并清除血肿。介入栓塞和手术夹闭大脑中动脉瘤均能有效防止动脉瘤再出血。
Objective To explore the treatment of middle cerebral artery aneurysm selection and efficacy. Methods Retrospective analysis of 111 cases of 114 middle cerebral artery aneurysms with surgical clipping and endovascular interventional treatment between January 2005 and July 2011 was retrospectively analyzed. Preoperative classification, aneurysm size, location, treatment outcome. Results Totally 90 aneurysms were occluded in 88 patients and were followed up for 15 d to 48 months (average 12.7 months). There were 89 aneurysms and 1 aneurysm remaining without recurrence. Endovascular interventional treatment of 23 patients with 24 aneurysms. There were 7 stent-assisted embolization, 3 balloon-assisted embolization, 12 embolization with microscopic coil, and 17 aneurysms were followed up from 1 to 37 months (mean 10.6 months), and 5 (29.4% Stent treatment of 2 (unruptured dissection aneurysm), 3 months after angiography follow-up, 1 aneurysm disappeared, 1 no change. Glasgow prognosis score in 5 to 4 points in 72 cases (81.8%), intervention in 21 cases (91.3%). Conclusions Narrow-necked (berry-like) middle cerebral artery aneurysms, surgical clipping and interventional embolization are not recur. Complex cerebral artery aneurysm surgery is not easy to relapse, interventional embolization is relatively easy to relapse. Middle cerebral artery aneurysm with hematoma (hematoma volume> 30 mL), select the surgery to close the aneurysm and remove the hematoma. Interventional embolization and surgical clipping of the middle cerebral artery aneurysm can effectively prevent aneurysm rebleeding.