小脑后下动脉远端破裂动脉瘤的血管内治疗

发布时间：2018-03-10 19:29

本文选题：小脑后下动脉　切入点：动脉瘤　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:小脑后下动脉(posterior inferior cerebellar artery,PICA)远端动脉瘤在颅内动脉瘤中发病率很低。目前小脑后下动脉远端动脉瘤治疗处理仍存在争议,缺乏大量的证据。除开颅动脉瘤夹闭术伴或不伴血管吻合术外,介入治疗也被一些研究证实同样较为安全和有效。但对于介入治疗的具体方法,闭塞载瘤动脉的安全性等仍需要更进一步的探讨。目的:通过回顾性分析我院小脑后下动脉远端破裂动脉瘤血管内介入治疗的患者,分析和对比闭塞载瘤动脉和单纯动脉瘤栓塞的差别,以及血管内治疗总体的有效性和安全性,并分析预后相关因素。方法:对2009年7月至2016年2月期间在我院行血管内治疗的小脑后下动脉远端破裂动脉瘤进行回顾性分析。并对比动脉瘤治疗的成功率,手术相关并发症及患者预后等因素。结果:本研究共纳入2009年7月至2016年2月间在我院首次确诊为PICA远端动脉瘤破裂并行介入栓塞治疗的患者36例。单纯动脉瘤栓塞8例,闭塞载瘤动脉28例。女性26(72.22%)例,男性10(27.78%)例。HuntHess分级中位数为3级。新发影像学部分小脑梗塞见于12(34.29%)例患者,其中3例患者术后意识模糊无明显改善,余9名未见神经功能异常。出院时21(77.14%)例恢复良好。术后一年28(84.85%)名患者恢复良好。术后2年及3年时分别为27(90%)例,20(90.91%)例。单纯栓塞动脉瘤和闭塞载瘤动脉的患者群体在mRS、手术相关并发症等方面无显著性差异。患者入院时的HuntHess分级、年龄、急性脑积水与其预后有相关关系。结论:除开颅夹闭术等治疗手段外,血管内介入治疗小脑后下动脉远端破裂动脉瘤有良好效果及较高的成功率。闭塞载瘤动脉与单纯动脉瘤栓塞均可根据患者具体情况进行选择作为治疗手段,虽然闭塞载瘤动脉可能导致部分小脑梗塞但不会对患者的生活能力造成明显影响。患者入院的HuntHess分级、年龄、急性脑积水与患者预后有相关关系。
[Abstract]:Background: the incidence of distal inferior cerebellar aneurysms in posterior inferior cerebellar artery is very low. At present, the treatment of distal posterior inferior cerebellar artery aneurysm is still controversial. In addition to intracranial aneurysm clipping with or without vascular anastomosis, interventional therapy has been proved to be equally safe and effective in some studies. The safety of occluded aneurysm carrier artery should be further discussed. Objective: to analyze the interventional therapy of ruptured distal posterior inferior cerebellar artery in our hospital. To analyze and compare the difference between occlusive and simple aneurysm embolization, and the overall efficacy and safety of endovascular treatment. Methods: the distal ruptured aneurysms of posterior inferior cerebellar artery treated in our hospital from July 2009 to February 2016 were analyzed retrospectively. Results: from July 2009 to February 2016, 36 patients with ruptured distal aneurysm of PICA and interventional embolization were included in this study. The median of HuntHess grade was 3. The new imaging part of cerebellar infarction was seen in 1234.29) patients, 3 of them had no obvious improvement in consciousness after operation. The remaining 9 patients had no abnormal neurological function. At discharge 2177.14) patients recovered well. One year after operation, 2884.85) patients recovered well. At 2 and 3 years after operation, there were 2790 patients and 2090.91patients, respectively. The group of patients who simply embolized aneurysms and occluded aneurysms was a group of patients. There was no significant difference in MRS, operation-related complications, etc. The HuntHess grade at admission, Age, acute hydrocephalus were correlated with prognosis. Conclusion: in addition to craniotomy and other treatment methods, Endovascular interventional treatment of ruptured aneurysms at the distal end of the posterior inferior cerebellar artery has a good effect and a high success rate. The occlusive aneurysm carrier artery and the simple aneurysm embolization can be selected as the treatment methods according to the specific conditions of the patients. Although the occluded aneurysm may lead to part of cerebellar infarction, it does not have a significant effect on the patients' living ability. The HuntHess grade, age, and acute hydrocephalus are correlated with the prognosis of the patients.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.12

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