Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake, Utah, USA.
J Neurol Neurosurg Psychiatry. 2018 Mar;89(3):277-286. doi: 10.1136/jnnp-2016-314477. Epub 2017 Oct 12.
Clinical outcomes have improved considerably over the last decade for patients with ruptured and unruptured aneurysms. Modern endovascular techniques, such as flow diversion, are associated with high aneurysm occlusion rates and have become a popular treatment modality for many types of aneurysms. However, the safety and effectiveness of flow diversion has not yet been established in trials comparing it with traditional aneurysm treatments. Moreover, there are some types of aneurysms that may not be appropriate for endovascular coiling, such as wide-necked aneurysms located at branch points of major vessels, large saccular aneurysms with multiple efferent arteries, dolichoectatic aneurysms, large aneurysms with mass effect, when there are technical complications with endovascular treatment, when patients cannot tolerate or have contraindications to antiplatelet therapy or in the setting of a subarachnoid haemorrhage. For these cases, open cerebrovascular surgery remains important. This review provides a discussion on the current trends and evidence for both flow diversion and open cerebrovascular surgery for complex aneurysms that may not be suitable for coiling. We emphasise a continued important role for surgical treatment in certain situations.
在过去的十年中，破裂和未破裂的动脉瘤患者的临床预后得到了显著改善。现代血管内技术，如血流导向装置，与高的动脉瘤闭塞率相关，并已成为许多类型的动脉瘤的一种流行的治疗方式。然而，血流导向装置的安全性和有效性在与传统的动脉瘤治疗进行比较的试验中尚未得到证实。此外，还有一些类型的动脉瘤可能不适合血管内线圈，如位于主要血管分支处的宽颈动脉瘤、有多个流出动脉的大型囊状动脉瘤、梭形扩张性动脉瘤、有肿块效应的大型动脉瘤，当存在血管内治疗的技术并发症时、当患者不能耐受或有抗血小板治疗的禁忌症时，或在蛛网膜下腔出血的情况下。对于这些病例，开颅脑血管手术仍然很重要。这篇综述讨论了血流导向装置和开颅脑血管手术治疗复杂动脉瘤的当前趋势和证据，这些动脉瘤可能不适合线圈。我们强调在某些情况下，手术治疗仍然具有重要作用。
