Jamróz Tomasz, Jakutowicz Izabela, Hofman Mariusz, Kołodkiewicz Marta, Ćmiel Maciej, Łapaj Anna, Przybyłko Nikodem, Bażowski Piotr, Baron Jan
School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
Department of Anaesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
Pol J Radiol. 2019 Sep 19;84:e360-e364. doi: 10.5114/pjr.2019.89159. eCollection 2019.
Very small intracranial aneurysms (VSIAs) may cause many neurological complications and even death. Thanks to technological progress and higher quality of non-invasive neuroimaging methods, these pathologies can be investigated sooner and treated earlier. Due to the controversy surrounding invasive treatment of these pathologies, the aim of the study was to analyse methods of treatment, their outcome, and complications in a group of patients with VSIAs.
Out of 444 cases of intracranial aneurysms treated in our centre, 65 aneurysms met the radiological criteria of VSIAs. The parameters - width and length of the aneurysm's neck and width, length, and height of the aneurysm's dome - were measured. The analysed parameters were as follows: symptoms upon admission and after treatment, days in hospital, and intraoperative complications. Clinical and radiological intensity of subarachnoid haemorrhage (SAH) was evaluated by using the Hunt-Hess and Fisher scales. The degree of embolisation of the aneurysm after the procedure was assessed using the Montreal Scale. Clinical outcome was assessed by Glasgow Outcome Scale.
50.77% of VSIAs were treated with endovascular procedures and 49.23% with neurosurgical clipping. SAH was presented in 38.46% of patients with VSIAs. Intraoperative complications were presented in 16.92% of patients with VSIAs, and the most common complication was ischaemic stroke. Stents were used in 51.52% of VSIAs. In 69.70% of embolisation procedures at VSIAs complete obliteration was achieved. The average result in the Montreal Scale was 1.31 (SD = 0.66).
VSIAs can be treated as effectively and safely as larger aneurysms, by both endovascular and surgical methods.
非常小的颅内动脉瘤（VSIA）可能导致许多神经并发症甚至死亡。由于技术进步和非侵入性神经成像方法质量的提高，这些病变能够更早地被研究和治疗。鉴于围绕这些病变的侵入性治疗存在争议，本研究的目的是分析一组VSIA患者的治疗方法、治疗结果及并发症。
在我们中心治疗的444例颅内动脉瘤病例中，65例动脉瘤符合VSIA的放射学标准。测量了动脉瘤颈的宽度和长度以及动脉瘤瘤体的宽度、长度和高度等参数。分析的参数包括：入院时及治疗后的症状、住院天数和术中并发症。采用Hunt-Hess和Fisher量表评估蛛网膜下腔出血（SAH）的临床和放射学强度。术后使用蒙特利尔量表评估动脉瘤的栓塞程度。采用格拉斯哥预后量表评估临床结局。
50.77%的VSIA采用血管内治疗，49.23%采用神经外科夹闭术。38.46%的VSIA患者出现SAH。16.92%的VSIA患者出现术中并发症，最常见的并发症是缺血性卒中。51.52%的VSIA使用了支架。在69.70% 的VSIA栓塞手术中实现了完全闭塞。蒙特利尔量表的平均结果为1.31（标准差=0.66）。
通过血管内和手术方法，VSIA能够像较大的动脉瘤一样有效且安全地进行治疗。
