Gobin Y P, Viñuela F, Gurian J H, Guglielmi G, Duckwiler G R, Massoud T F, Martin N A
Department of Radiology, University of California, Los Angeles Medical Center, USA.
J Neurosurg. 1996 Jan;84(1):55-62. doi: 10.3171/jns.1996.84.1.0055.
Results in nine patients with large or giant fusiform intracranial aneurysms that were treated with Guglielmi detachable coils (GDCs) are reported. There were six males and three females between the ages of 12 and 63. Four patients presented with subarachnoid hemorrhage (SAH) and four with mass effect; in one patient the aneurysm was asymptomatic and located in an arterial feeder of an arteriovenous malformation. Five aneurysms were supratentorial and four were in the posterior fossa. Five were giant and four were large. Selective occlusion with preservation of the parent artery was attempted in three cases, and complete occlusion of the aneurysm and the parent artery was performed in six patients. The tolerance to parent artery occlusion was assessed by angiography, balloon test occlusion, and amytal testing. Six aneurysms were permanently occluded and two partially recanalized. In one case, GDC embolization was not possible. The four patients who presented with SAH made an excellent clinical recovery. Three of the four patients presenting with mass effect recovered completely and one remained unchanged. The patient with an incidental aneurysm remained asymptomatic. There were no permanent complications. In conclusion, GDCs were useful for the occlusion of large and giant intradural fusiform aneurysms. Occlusion of the aneurysm and the parent artery afforded the greatest opportunity for a complete cure. Advantages of GDCs compared to balloons include: occlusion of a shorter segment of normal artery, no traction on the parent vessel, and safer and easier catheterization techniques.
报告了9例采用 Guglielmi 可脱卸弹簧圈（GDC）治疗的大型或巨大型颅内梭形动脉瘤患者的结果。患者年龄在12至63岁之间，男性6例，女性3例。4例患者表现为蛛网膜下腔出血（SAH），4例有占位效应；1例患者的动脉瘤无症状，位于动静脉畸形的动脉供血支。5例动脉瘤位于幕上，4例位于后颅窝。5例为巨大型，4例为大型。3例尝试选择性闭塞并保留载瘤动脉，6例患者对动脉瘤和载瘤动脉进行了完全闭塞。通过血管造影、球囊试验闭塞和阿米妥试验评估对载瘤动脉闭塞的耐受性。6例动脉瘤永久性闭塞，2例部分再通。1例无法进行GDC栓塞。4例表现为SAH的患者临床恢复良好。4例有占位效应的患者中，3例完全恢复，1例无变化。偶然发现的动脉瘤患者仍无症状。无永久性并发症。总之，GDC对大型和巨大型硬脑膜内梭形动脉瘤的闭塞是有用的。动脉瘤和载瘤动脉的闭塞为完全治愈提供了最大机会。与球囊相比，GDC的优点包括：正常动脉闭塞段较短，对载瘤血管无牵拉，导管插入技术更安全、更容易。
