Halbach V V, Higashida R T, Dowd C F, Barnwell S L, Fraser K W, Smith T P, Teitelbaum G P, Hieshima G B
Department of Radiology (Neurointerventional Section), University of California Medical Center, San Francisco.
J Neurosurg. 1994 Apr;80(4):659-66. doi: 10.3171/jns.1994.80.4.0659.
Endovascular obliteration of intracranial aneurysms with preservation of the parent artery (endosaccular occlusion) has been advocated for patients who fail or are excluded from surgical clipping and cannot undergo Hunterian ligation therapy. To clarify the effect that endosaccular occlusion has on the presenting neurological signs, 26 patients with aneurysms and symptoms related to mass effect who underwent this therapy were followed for a mean of 60 months. Only patients with objective neurological deficits who had not suffered a hemorrhage were included in this series. Response to therapy was classified into one of three groups: "resolved," if the patient had complete resolution of presenting signs; "improved," if significant and sustained improvement was recorded in the neurological examinations, and "unchanged," if no change was observed. Thirteen patients (50%) were classified as resolved, 11 (42.3%) as improved, and two (7.7%) as unchanged. A comparison of patients classified as resolved with those who were improved revealed that the former group had less wall calcification (30% vs. 60%) and a shorter duration of symptoms. Patients with neurological sign resolution (62%) were more likely to have totally occluded aneurysms on late follow-up arteriograms than those who had improvement (28%) or were unchanged (0%). This study suggests that endosaccular embolization therapy can improve or alleviate presenting neurological signs unrelated to hemorrhage or distal embolization in the majority of cases.
对于手术夹闭失败或不适合手术夹闭且无法接受亨特结扎术治疗的患者，提倡采用保留载瘤动脉的颅内动脉瘤血管内闭塞术（囊内闭塞）。为了阐明囊内闭塞对所出现神经体征的影响，对26例患有动脉瘤且有与占位效应相关症状并接受该治疗的患者进行了平均60个月的随访。本系列仅纳入未发生出血且有客观神经功能缺损的患者。治疗反应分为三组之一：“缓解”，如果患者所出现的体征完全消失；“改善”，如果神经检查记录到显著且持续的改善；“未改变”，如果未观察到变化。13例患者（50%）被分类为缓解，11例（42.3%）为改善，2例（7.7%）为未改变。将分类为缓解的患者与改善的患者进行比较发现，前一组的壁钙化较少（30%对60%）且症状持续时间较短。在晚期随访血管造影片上，神经体征缓解的患者（62%）比改善的患者（28%）或未改变的患者（0%）更有可能出现动脉瘤完全闭塞。本研究表明，在大多数情况下，囊内栓塞治疗可改善或减轻与出血或远端栓塞无关的所出现神经体征。
