Nakagawa Ichiro, Park Hun Soo, Kotsugi Masashi, Morisaki Yudai, Wada Takeshi, Aketa Shuta, Takayama Katsutoshi, Fujimoto Kenta, Deguchi Jun, Kichikawa Kimihiko, Nakase Hiroyuki
Department of Neurosurgery, Nara Medical University, Nara, Japan.
Department of Radiology, Nara Medical University, Nara, Japan.
Oper Neurosurg. 2020 Jul 1;19(1):76-83. doi: 10.1093/ons/opz299.
With the recent advances in endovascular treatment devices, it has become standard in wide-neck or large intracranial aneurysms to perform coil embolization with adjunctive techniques. However, device-related perioperative complications have been reported because of the use of more complex systems.
To investigate patients who developed multiple parenchymal lesions after undergoing coil embolization for treating an unruptured intracranial aneurysm.
This study investigated 305 consecutive patients who underwent coil embolization of unruptured intracranial aneurysms between 2015 and 2017. Delayed inflammatory changes referred to the delayed observation of multiple cerebral white matter lesions on follow-up magnetic resonance imaging at an area corresponding to the perfused area of the treatment target vessel. The timing and pattern of onset, device used, the combined use of adjunctive techniques, and the clinical course after steroid treatment were retrospectively investigated.
The 7 patients (2.3%) who showed delayed inflammatory changes were all women with a mean age of 59 yr. A mean duration from treatment to onset was 28 d. Symptoms were convulsions in 3 patients, hemiplegia in 2 patients, and homonymous hemianopia in 1 patient. All 7 patients were treated with adjunctive technique including stents, double catheter method, and balloon assist. Response to steroid treatment was satisfactory both clinically and on imaging in all 7 patients. Skin patch test was positive for nickel allergy in 2 patients.
Clinicians must be fully aware of symptomatic delayed inflammatory changes may occur after endovascular aneurysmal treatment with the use of various devices.
随着血管内治疗设备的最新进展，对于宽颈或大型颅内动脉瘤，采用辅助技术进行弹簧圈栓塞已成为标准治疗方法。然而，由于使用了更复杂的系统，已报道了与设备相关的围手术期并发症。
调查在接受未破裂颅内动脉瘤弹簧圈栓塞治疗后出现多个实质病变的患者。
本研究调查了2015年至2017年间连续305例接受未破裂颅内动脉瘤弹簧圈栓塞治疗的患者。延迟性炎症变化是指在随访磁共振成像中，在与治疗目标血管灌注区域相对应的区域观察到多个脑白质病变的延迟情况。回顾性调查发病的时间和模式、使用的设备、辅助技术的联合使用情况以及类固醇治疗后的临床病程。
出现延迟性炎症变化的7例患者（2.3%）均为女性，平均年龄59岁。从治疗到发病的平均时间为28天。症状包括3例抽搐、2例偏瘫和1例同向性偏盲。所有7例患者均接受了包括支架、双导管法和球囊辅助在内的辅助技术治疗。所有7例患者在临床和影像学上对类固醇治疗的反应均令人满意。2例患者的皮肤斑贴试验镍过敏呈阳性。
临床医生必须充分意识到，在使用各种设备进行血管内动脉瘤治疗后，可能会出现有症状的延迟性炎症变化。
