CAJ | 학술논문

目的探讨颅内镜像动脉瘤的临床特点和治疗策略.方法回顾性研究2007年11月至2012年11月治疗的19例20对颅内镜像动脉瘤患者资料.其中男性6例,女性13例,年龄32～75岁,平均56岁.双侧后交通动脉瘤11例(其中1例伴发双侧脉络膜前动脉瘤),双侧大脑中动脉分叉部动脉瘤4例,双侧床突旁动脉瘤3例,双侧胼周-胼缘动脉瘤1例.根据出血部位、Hunt-Hess临床分级、动脉瘤的部位、大小等制定手术策略.结果一期同时夹闭两侧动脉瘤4例,二期分次夹闭两侧动脉瘤3例,手术夹闭联合介入栓塞动脉瘤2例,只处理一侧动脉瘤10例.出院时格拉斯哥评分(GOS)5分者15例(15/19),4分(轻残)4例(4/19).术后随访3～ 50个月,平均18.6个月.2例术后出现动眼神经麻痹,随访3个月1例恢复,1例未好转.10例对侧动脉瘤未处理者动脉瘤直径均小于5 mm且形态规则,为未破裂动脉瘤.9例一期或二期处理双侧镜像动脉瘤的患者随访时无动脉瘤残颈或复发.结论颅内镜像动脉瘤是多发动脉瘤的一种特殊类型,应优先处理责任动脉瘤,对侧未破裂动脉瘤可以采取观察、一期同时处理或二期延期处理等策略.
목적 탐토로내경상동맥류적림상특점화치료책략.방법 회고성연구2007년11월지2012년11월치료적19례20대로내경상동맥류환자자료.기중남성6례,녀성13례,년령32～75세,평균56세.쌍측후교통동맥류11례(기중1례반발쌍측맥락막전동맥류),쌍측대뇌중동맥분차부동맥류4례,쌍측상돌방동맥류3례,쌍측변주-변연동맥류1례.근거출혈부위、Hunt-Hess림상분급、동맥류적부위、대소등제정수술책략.결과 일기동시협폐량측동맥류4례,이기분차협폐량측동맥류3례,수술협폐연합개입전새동맥류2례,지처리일측동맥류10례.출원시격랍사가평분(GOS)5분자15례(15/19),4분(경잔)4례(4/19).술후수방3～ 50개월,평균18.6개월.2례술후출현동안신경마비,수방3개월1례회복,1례미호전.10례대측동맥류미처리자동맥류직경균소우5 mm차형태규칙,위미파렬동맥류.9례일기혹이기처리쌍측경상동맥류적환자수방시무동맥류잔경혹복발.결론 로내경상동맥류시다발동맥류적일충특수류형,응우선처리책임동맥류,대측미파렬동맥류가이채취관찰、일기동시처리혹이기연기처리등책략.
Objective To study the clinical characteristics and treatment strategies of mirror aneurysms.Methods Nineteen patients with 20 pairs of mirror aneurysms from November 2007 to November 2012 were retrospectively analysed.Among the 19 patients,13 were female and 6 were male,mean age was 56 years (ranged 32-75 years).Distribution of the lesions included 11 bilateral posterior communicating artery aneurysms (one with a pair of anterior choroidal artery aneurysm),4 bilateral middle cerebral artery aneurysms,3 bilateral paraclinoidal aneurysms,and 1 bilateral pericallosal-callosomarginal artery aneurysm.Surgical strategies were selected according to location of hemorrhage,Hunt-Hess grade,location and size of aneurysm,etc.Results Four mirror aneurysms were clipped at one stage,3 mirror aneurysms were clipped at two stages,2 were treated with combination of clipping and coiling and remaining 10 were clipped unilaterally.At discharge,15 out of 19 patients had a Glasgow Outcome Scale score of 5,4 patients had a score of 4.The mean clinical follow-up was 18.6 months (range 3-50 months).Two patients had oculomotor nerve palsy postoperatively.At 3-month follow-up,1 improved and 1 unchanged.In 10 patients with unilateral clipping,contralateral aneurysms were unruptured,small (＜5 mm) and regular.No remnant or recurrence of aneurysm were found in other 9 patients whose bilateral aneurysms had been treated.Conclusions The mirror aneurysms are rare kinds of multiple aneurysms.The aneurysm responsible for hemorrhage should be treated with first priority.The contralateral unruptured aneurysm could be observed,clipped or coiled in one stage,or treated in two separate stages.