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目的探讨颅内多发动脉瘤的3D-CTA诊断价值和开颅动脉瘤颈夹闭和(或)血管内栓塞治疗效果。方法回顾性分析39例经3D-CTA确诊的颅内多发动脉瘤临床资料,36例采用开颅动脉瘤颈夹闭和/或血管内栓塞治疗,一期单侧翼点入路开颅动脉瘤颈夹闭术18例,双侧翼点或翼点+前纵裂入路动脉瘤颈夹闭术6例;二期开颅动脉瘤颈夹闭术3例;开颅动脉瘤颈夹闭术+血管内栓塞术4例;单纯血管内栓塞术5例。手术夹闭动脉瘤颈64个,血管内栓塞14个,11个动脉瘤未予处理。结果39例共发现动脉瘤89个,其中2个动脉瘤30例,3个动脉瘤7例,4个动脉瘤2例;31例术后复查3D-CTA,其中30例显示动脉瘤夹闭良好或完全栓塞,1例动脉瘤颈夹闭不全术后一个月动脉瘤再次破裂出血,再次开颅手术夹闭,痊愈出院,随访3个月至7年,按GOS预后分级,良好29例,轻残5例,重残2例,死亡3例均因动脉瘤再次破裂未处理。结论3D-CTA可靠、快捷、安全,可作为颅内多发动脉瘤的首选诊断方法,开颅动脉瘤颈夹闭和/或血管内栓塞治疗效果良好。
Objective To investigate the diagnostic value of 3D-CTA for intracranial multiple aneurysms and the effect of craniotomy and / or endovascular embolization in craniotomy. Methods The clinical data of 39 patients with intracranial aneurysm diagnosed by 3D-CTA were retrospectively analyzed. Thirty-six patients underwent craniotomy and / or endovascular embolization. One Occlusion in 18 cases, bilateral wing points or wing points + anterior longitudinal split neck artery occlusion in 6 cases; 2 craniotomy aneurysm neck clamp in 3 cases; craniotomy aneurysm neck clamp + 4 cases of endovascular embolization; simple endovascular embolization in 5 cases. Surgical closure of aneurysm neck 64, 14 intravascular embolization, 11 aneurysms were not treated. Results A total of 89 aneurysms were found in 39 cases, including 30 cases of 2 aneurysms, 7 cases of 3 aneurysms and 2 cases of 4 aneurysms. The 3D-CTA was reviewed in 31 cases and the aneurysm was well occluded in 30 cases Or complete embolism, 1 case of aneurysm neck aneurysm aneurysm rupture again bleeding a month after surgery, closed craniotomy again, discharged from hospital, followed up for 3 months to 7 years, according to GOS prognosis, good in 29 cases, light 5 cases of residual, 2 cases of severe disability, 3 cases of death were ruptured again because of aneurysms untreated. Conclusion 3D-CTA is reliable, rapid and safe and can be used as the first choice for the diagnosis of intracranial multiple aneurysms. The treatment of neck-closed and / or endovascular embolization of cranial aneurysm is effective.