Department of Interventional Radiology, 1st Affiliated Hospital of Dalian Medical University, Dalian, China.
Neuroradiology. 2013 Nov;55(11):1345-53. doi: 10.1007/s00234-013-1270-6. Epub 2013 Aug 15.
Incomplete surgical treatment of intracranial aneurysms and recurrent postsurgical aneurysms are associated with a risk of rebleeding, and additional treatment is generally recommended. Surgical retreatment may carry a risk of procedural complications due to technical difficulty. We present here our experience with the endovascular approach for the retreatment of intracranial aneurysms that were initially treated with open surgery.
From January 2002 through January 2013, a total of 43 patients with 43 postsurgical index aneurysms were identified and underwent subsequent endovascular treatment. Clinical and radiological data were retrospectively reviewed.
Thirty-one patients were surgically clipped before endovascular coiling and 12 patients were nonclipped, which included wrapping. Hemorrhagic presentation occurred in 21 patients prior to coiling. The interval between the initial surgical treatment and coiling varied from 0 days to 264 months (median, 9 months). Endovascular coiling resulted in the successful occlusion of 36 aneurysms (84 %). Procedure-related complications included asymptomatic thrombus formation in six patients, symptomatic cerebral infarction in two patients, and retroperitoneal hemorrhage in one patient. Delayed cerebral infarction occurred in two patients with a deployed stent. The procedure-related permanent morbidity and mortality rates were 6.9 and 0 %, respectively. Radiological follow-up evaluations beyond 6 months were available in 26 patients (60 %), which revealed major recanalization in three patients (11.5 %). There was no rebleeding during the follow-up period, which ranged from 3 to 115 months (mean, 34.5 months).
Endovascular embolization may serve as a safe, efficacious, and durable treatment option in the management of postsurgical intracranial aneurysms.
颅内动脉瘤手术不彻底和复发性手术后动脉瘤与再出血风险相关，一般建议进行额外治疗。由于技术难度，手术再治疗可能会带来手术并发症的风险。我们在此介绍我们对最初采用开颅手术治疗的颅内动脉瘤进行血管内治疗的经验。
从 2002 年 1 月至 2013 年 1 月，共有 43 名患者的 43 个手术后的索引动脉瘤被确定，并接受了随后的血管内治疗。回顾性地审查了临床和影像学数据。
31 名患者在血管内线圈之前进行了手术夹闭，12 名患者未夹闭，其中包括包裹。在进行线圈治疗前，21 名患者出现了出血表现。初始手术治疗与线圈之间的时间间隔从 0 天到 264 个月（中位数为 9 个月）。血管内线圈成功地闭塞了 36 个动脉瘤（84%）。与手术相关的并发症包括 6 名患者无症状血栓形成、2 名患者症状性脑梗死和 1 名患者腹膜后出血。2 名使用支架的患者发生了迟发性脑梗死。与手术相关的永久性发病率和死亡率分别为 6.9%和 0%。26 名患者（60%）进行了超过 6 个月的影像学随访评估，其中 3 名患者（11.5%）发现了主要再通。在随访期间没有再出血，随访时间为 3 至 115 个月（平均 34.5 个月）。
血管内栓塞可能是治疗手术后颅内动脉瘤的一种安全、有效和持久的治疗选择。
