摘要
目的探讨介入治疗在心房黏液瘤相关性颅内动脉瘤治疗中的可行性、安全性及有效性。方法连续纳入2018年4月至2021年4月海军军医大学第一附属医院脑血管病中心收治的4例心房黏液瘤相关性颅内动脉瘤患者并对其临床和影像学资料进行回顾性分析,复习与心房黏液瘤相关性颅内动脉瘤发病机制及治疗相关的文献。临床资料包括患者既往史、临床症状、治疗方法、治疗结果及随访情况(包括随访方式、时间及随访结果)等,影像学资料包括颅内动脉瘤个数、部位及形态、大小(最大径、瘤宽、瘤高)等。4例心房黏液瘤相关性颅内动脉瘤均采用介入栓塞治疗。记录手术成功率、围手术期并发症(包括术中动脉瘤破裂出血、载瘤动脉缺血、血管痉挛等)。采用Raymond-Roy分级评价动脉瘤栓塞效果(Ⅰ级为完全栓塞,Ⅱ级为瘤颈显影,Ⅲ级为瘤体显影)。术后6个月以上,通过住院的方式对患者进行临床随访(有无出现新发症状)及影像学随访(采用头部CT血管成像、DSA方式评估动脉瘤是否复发、支架内是否再狭窄)。结果4例患者临床表现为蛛网膜下腔出血1例,一过性意识障碍1例,头痛1例,1例为体格检查发现;其中多发颅内动脉瘤3例(共6个动脉瘤),单发1例;梭形动脉瘤5个,囊状动脉瘤2个。7个颅内动脉瘤均成功实施介入栓塞术。围手术期无缺血、出血及血管痉挛等并发症,栓塞效果均为Raymond-Roy分级Ⅰ级。术后半年后随访,所有患者随访治愈,无新发症状、支架内再狭窄及栓塞动脉瘤的破裂出血事件。结论心房黏液瘤相关性颅内动脉瘤多为梭形、多发动脉瘤,可考虑将介入治疗作为一线治疗方案,但其远期复发率及有效性仍需大样本、长期随访来证实。
Objective To evaluate the feasibility,safety and efficacy of interventional treatment for atrial myxoma-related intracranial aneurysms.Methods Clinical and imaging data of 4 patients with atrial myxoma-related intracranial aneurysms treated by interventional embolization in Neurovascular Center of the First Affiliated Hospital of Naval Medical University from April 2018 to April 2021 were retrospectively collected and analyzed.Also,literatures about pathogenesis and treatment of atrial myxoma-related intracranial aneurysms were reviewed.Clinical data included patients′past history,clinical symptoms,treatment methods and results,follow-up(including follow-up method,time and results),etc.The imaging data included the number,location,shape,size(maximum diameter,width,height)of intracranial aneurysms.All 4 patients were treated with interventional embolization for atrial myxoma-related intracranial aneurysms,and the success rate of surgery and perioperative complications(including intraoperative aneurysm rupture and hemorrhage,parent artery ischemia,vasospasm,etc.)were recorded.The embolization effect of aneurysms was evaluated by postoperative Raymond-Roy classification(gradeⅠ:complete obliteration,gradeⅡ:residual neck,gradeⅢ:residual body).More than six months after the operation,the patients were hospitalized for clinical follow-up(whether new symptoms or not)and imaging follow-up(head CT angiography and DSA to evaluate whether the aneurysm recurred and whether in-stent restenosis occurred).Results The clinical manifestations were subarachnoid hemorrhage in 1 case,transient disturbance of consciousness in 1 case,headache in 1 case,and found during physical examination in 1 case.There were 3 cases of multiple intracranial aneurysms(6 aneurysms in total)and 1 case of single aneurysm.There were 5 fusiform aneurysms and 2 cystic aneurysms.Interventional embolization was successfully performed on all intracranial aneurysms.There were no complications such as ischemia,hemorrhage and vasospasm during perioperative period,and all achieved Raymond-Roy gradeⅠafter embolization.Six months after the operation,all patients were followed up and cured,and no new symptoms,stent restenosis or rupture of embolized aneurysm occurred.Conclusions Preliminary experience showed that fusiform and multiple characteristics were commonly seen in atrial myxoma-related aneurysms.Interventional embolization could be potential first-line treatment for those aneurysms,but still warrants further large sample trials with long-term follow-up.
作者
彭哲
张小曦
邓晓东
周宇
李司司
洪波
戴冬伟
Peng Zhe;Zhang Xiaoxi;Deng Xiaodong;Zhou Yu;Li Sisi;Hong Bo;Dai Dongwei(Cerebrovascular Disease Center,the First Affiliated Hospital of Naval Military Medical University,Shanghai 200433,China)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2021年第11期778-783,共6页
Chinese Journal of Cerebrovascular Diseases
基金
衡阳市科技计划项目(衡科发[2019]47号-191)。
关键词
心房黏液瘤
颅内动脉瘤
介入治疗
多发动脉瘤
梭形
Atrial myxoma
Intracranial aneurysm
Interventional therapy
Multiple aneurysms
Fusiform
