颅内夹层动脉瘤的诊断及治疗（附9例病例资料）

发布时间：2018-02-02 17:04

  本文关键词： 颅内夹层动脉瘤 诊断 治疗　出处：《吉林大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：目前国内关于颅内夹层动脉瘤（Intracranial DissectingAneurysm,IDA）的临床研究甚少。本研究总结9例IDA患者的临床资料及治疗经验,探讨其血管内治疗方案的选择及疗效。 临床资料和方法：2008年12月至2014年12月间在吉林大学中日联谊医院神经外一科收治IDA患者9例，男6例,女3例，年龄31~62岁,平均48.9岁，合并高血压病史2例、肺部感染2例，均无明显头颈部外伤史。首发临床表现：头痛7例，意识不清2例，抽搐2例，头晕2例，恶心呕吐4例，言语不清、肢体活动不灵等缺血症状1例，抽搐、头晕头痛、恶心呕吐等占位性症状1例。均经DSA或CTA检查确诊。头部CT检查，1例头部CT未见蛛网膜下腔出血，示蝶鞍增大，向右后方突出，可见团块状高密度影及斑片状钙化，局部可见骨质破坏。其余8例患者示蛛网膜下腔出血，Hunt-Hess分级Ⅱ级6例、Ⅲ级2例，其中2例为二次破裂。DSA检查示9例患者均有不同程度的不规则官腔狭窄，其中1例造影可显示双腔征（对比剂在血管腔与壁内血肿内同时显影）、双向血流、晚期动脉显像造影剂夹层内滞留等夹层动脉的直接征象。9例中2例属于颈内动脉系IDA，分别采用单支架辅助弹簧圈栓塞术和球囊闭塞术。7例属于椎-基底动脉系IDA，其中5例IDA位于PICA起始部远端，2例IDA位于PICA起始部处。7例中1例PICA起始部远端IDA因经济原因不接受血管内介入手术，采用开颅夹层动脉瘤孤立术，2例PICA起始部远端IDA和1例PICA起始部IDA均采用单纯弹簧圈栓塞术，1例PICA起始部远端IDA采用单支架辅助弹簧圈栓塞术，1例PICA起始部IDA和1例PICA起始部远端IDA均采用双支架辅助弹簧圈栓塞术。 结果：9例IDA患者中开颅夹层动脉瘤孤立术1例，单纯球囊闭塞术1例，单纯弹簧圈闭塞术3例，单支架辅助弹簧圈栓塞术2例，,双支架辅助弹簧圈栓塞术2例。随访1个月至6年，平均34.7个月。9例患者中7例治愈，，1例出现一侧基底节区脑梗死，1例死亡。 结论：IDA早期诊断、早期治疗预后良好。二次破裂的IDA致死率及致残率极高,临床预后极差。DSA检查是IDA诊断的金标准。IDA血管内治疗为一个安全可靠的治疗方法。治疗方案应根据其临床症状、IDA形态、发生部位而确定。根据病人情况综合分析行个体化血管内治疗很重要。
[Abstract]:Objective: to investigate the intracranial dissecting aneurysm Intracranial DissectingAneurysm in China. This study summarized the clinical data and treatment experience of 9 patients with IDA, and discussed the choice and effect of endovascular treatment. Clinical materials and methods: from December 2008 to December 2014, 9 IDA patients (6 males and 3 females, aged 31 or 62 years) were treated in the Department of Neurology, Sino-Japanese Friendship Hospital, Jilin University. The average age was 48.9 years old. There were 2 cases of hypertension and 2 cases of pulmonary infection. The first clinical manifestations were headache in 7 cases, confusion in 2 cases, convulsion in 2 cases, dizziness in 2 cases. There were 4 cases of nausea and vomiting, 1 case of poor speech, 1 case of ischemic symptoms, 1 case of convulsion, dizziness, headache, nausea and vomiting. All cases were diagnosed by DSA or CTA. There was no subarachnoid hemorrhage on CT in one case, which showed enlargement of the Sella turcica, protruding to the right posterior, mass high density shadow and patchy calcification, local bone destruction, and subarachnoid hemorrhage in the other 8 cases. There were 6 cases of grade 鈪

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