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目的探讨假性成分为主的“葫芦状”动脉瘤的影像学特点、诊断与治疗策略。方法回顾性分析6例颅内真性动脉瘤-假性动脉瘤复合体患者的临床资料。结果本组6例CT提示蛛网膜下腔出血,伴有脑实质内血肿。数字减影血管成像(digitalsubtraction angiography,DSA)或者磁共振血管成像检查提示颅内动脉瘤,5例前交通动脉瘤,1例左侧大脑中动脉瘤;3D-DSA重建提示动脉瘤由大、小两部分构成,均为小母囊上发出较大的子囊。本组5例前交通动脉瘤均行弹簧圈栓塞术,2例术后出现严重脑组织肿胀,1例急诊行去骨瓣减压及动脉瘤夹闭术后逐渐恢复,1例死亡;大脑中动脉瘤行开颅夹闭术。2例开颅手术患者术后病理均提示假性动脉瘤成分。5例出院患者预后良好,均随访3个月,临床症状稳定。结论葫芦状动脉瘤是一种以假性动脉瘤成分为主的特殊形态的动脉瘤复合体,有其独特的病理生理过程和影像学特点,治疗上强调根据个体情况及动脉瘤形态学特点选择最佳治疗方法尽早修复动脉瘤。
Objective To investigate the imaging features, diagnosis and treatment strategies of the “gourd-shaped” aneurysm with predominant false component. Methods The clinical data of 6 patients with intracranial true aneurysm - pseudoaneurysm complex were retrospectively analyzed. Results The group of 6 cases of CT showed subarachnoid hemorrhage, accompanied by intracerebral hematoma. Digital subtraction angiography (DSA) or magnetic resonance angiography revealed intracranial aneurysms, 5 anterior communicating aneurysms, and 1 left middle cerebral artery aneurysm. 3D-DSA reconstruction indicated that the aneurysms consisted of large and small Two parts, are issued on the small capsule on the larger ascus. The group of 5 cases of anterior communicating artery aneurysms were performed coil embolization, 2 cases of severe brain swelling occurred after surgery, 1 case of emergency ciliary flap decompression and aneurysm clipping recovery, 1 case of death; in the brain Aneurysm craniotomy clipping. Two cases of craniotomy patients postoperative pathology showed false aneurysm components. Five patients discharged with good prognosis, were followed up for 3 months, the clinical symptoms were stable. Conclusions Gourd-shaped aneurysm is a special form of aneurysm complex mainly composed of pseudoaneurysms. It has its own unique pathophysiological process and imaging features. The treatment emphasizes the selection of aneurysm according to the individual conditions and the morphological features of the aneurysm The best treatment for aneurysm repair as soon as possible.