Tone O, Tomita H, Tamaki M, Akimoto H, Shigeta K, Sampetrean O, Fujii M
Department of Neurosurgery, Musashino Red Cross Hospital; Tokyo, Japan.
Interv Neuroradiol. 2006 Jan 20;12(Suppl 1):97-100. doi: 10.1177/15910199060120S114. Epub 2006 Jun 15.
Small ruptured cerebral aneurysms, such as those of 2x3 mm diameter, are considered to be difficult to embolize by detachable coils because of the risk of procedural perforation of the aneurysms. We have treated these small aneurysms and report the techniques and pitfalls of these embolizations. Twenty-four patients with ruptured cerebral aneurysms of 2x3 mm diameter were intended for treatment by coil embolization. Before coil embolization, three-dimensional digital subtraction angiography was performed, and the simulation of the volume embolization ratio (VER) was performed in all patients, except for the first basilar artery aneurysm patient. The tip of the microcatheter was steam-shaped several times and was placed on the neck of the aneurysm. A balloon neck remodeling technique was used for two aneurysms. GDC 10 softs and soft SRs were used for the first ten aneurysms, and Ultrasofts were used for the last eleven aneurysms. Out of twentyfour aneurysm embolizations, we aborted the procedure in three cases, because of a failure in catheterization; we performed clipping surgery for these cases. For the first case of a basilar tip aneurysm, the aneurysm was perforated, due to the use of too long a coil and the insertion of the tip of the microcatheter into the aneurysmal dome. Minor infarction occurred in one patient. The mean VER was 33.9%, and two aneurysms recanalized, and out of these one needed a second embolization. Six months postoperatively, 81% of patients had made in a good recovery or had a moderate disability.We recommend the following techniques to embolize aneurysms of 2x3 mm diameter: the tip of the microcatheter should be stabilized on the aneurysmal neck by steam shaping of the microcatheter, GDC 10 soft and Ultrasoft should be selected for use, and the simulation of the VER should be performed before embolization to select coils of a suitable length.
小型破裂脑动脉瘤，比如直径为2×3毫米的动脉瘤，由于在栓塞过程中存在动脉瘤穿孔的风险，被认为难以用可脱卸弹簧圈进行栓塞治疗。我们对这些小型动脉瘤进行了治疗，并报告了这些栓塞治疗的技术及相关问题。24例直径为2×3毫米的破裂脑动脉瘤患者拟行弹簧圈栓塞治疗。在进行弹簧圈栓塞之前，除了第一例基底动脉动脉瘤患者外，所有患者均进行了三维数字减影血管造影，并进行了体积栓塞率（VER）模拟。微导管尖端多次塑形呈水滴状后置于动脉瘤颈部。有两个动脉瘤采用了球囊颈部重塑技术。前10个动脉瘤使用GDC 10软圈和软SR圈，后11个动脉瘤使用超软圈。在24次动脉瘤栓塞治疗中，有3例因插管失败而中止操作，对这些病例我们进行了夹闭手术。对于第一例基底动脉尖部动脉瘤，由于使用的弹簧圈过长且微导管尖端插入动脉瘤瘤腔内，导致动脉瘤穿孔。有1例患者发生了轻微梗死。平均VER为33.9%，有两个动脉瘤发生再通，其中一个需要再次栓塞。术后6个月，81%的患者恢复良好或有中度残疾。我们推荐以下技术用于栓塞直径为2×3毫米的动脉瘤：通过微导管塑形将微导管尖端稳定在动脉瘤颈部，应选择GDC 10软圈和超软圈，并在栓塞前进行VER模拟以选择合适长度的弹簧圈。
