Raymond J, Roy D, Bojanowski M, Moumdjian R, L'Espérance G
Department of Radiology, Hôpital Notre-Dame, Montreal, Quebec, Canada.
J Neurosurg. 1997 Feb;86(2):211-9. doi: 10.3171/jns.1997.86.2.0211.
The surgical treatment of basilar bifurcation aneurysms is difficult and the need for an alternative approach is frequently stated. To assess the efficacy and safety of endovascular treatment of aneurysms located at the basilar bifurcation, the authors prospectively studied angiographic results, clinical results, and complications in 31 patients treated with Guglielmi detachable coils (GDCs). Patients treated acutely after subarachnoid hemorrhage (SAH) were graded according to the Hunt and Hess classification and clinical outcome was determined at 1- and 6-month intervals according to the Glasgow Outcome Scale (GOS). There were 18 women and 13 men, ranging in age from 34 to 67 years (mean age 48 years). Twenty-three were treated acutely after SAH. Clinical Hunt and Hess grades at presentation were as follows: Grade I, six patients; Grade II, three; Grade III, 11; Grade IV, two; and Grade V, one. The GOS score for the group of patients treated acutely was: GOS I, 18 patients; GOS II, III, and IV, one patient each; and GOS V, two patients. There were seven technical complications in this group, most often asymptomatic, but one patient died after aneurysm rupture during treatment and one had residual diplopia at 4 months. Eight patients were treated for incidental basilar bifurcation aneurysms. One technical complication with no neurological deficit occurred in this group of patients with incidental aneurysms. Immediate angiographic results were considered to be satisfactory in 94% of patients, with complete obliteration in 42% and residual neck and dog ears in 52%. There was no bleeding episode after treatment during clinical follow-up periods ranging from 3 to 42 months (mean 15.5 months in 29 surviving patients). Angiographic results were available for 27 patients at 6 months and were as follows: 30% of the lesions were completely obliterated, 59% presented some residual neck, and 11% showed some opacification of the aneurysm sac. During the follow-up period of up to 42 months, a total of seven recurrences were noted, necessitating retreatment with GDCs in five patients. Endovascular treatment of basilar bifurcation aneurysms prevented rebleeding and could be performed without clinically significant complications in 94% of patients. Clinical results after SAH compared favorably with surgical series. Morphological results appear less satisfactory, and long-term angiographic follow-up review is mandatory to detect recurrences.
基底动脉分叉部动脉瘤的外科治疗难度较大，人们常常提到需要采用其他方法。为了评估血管内治疗基底动脉分叉部动脉瘤的疗效和安全性，作者前瞻性地研究了31例使用 Guglielmi 可脱卸弹簧圈（GDC）治疗患者的血管造影结果、临床结果及并发症。蛛网膜下腔出血（SAH）后接受急诊治疗的患者根据Hunt和Hess分级进行分级，并根据格拉斯哥预后量表（GOS）在1个月和6个月时确定临床结局。患者中有18名女性和13名男性，年龄在34至67岁之间（平均年龄48岁）。23例患者在SAH后接受急诊治疗。就诊时临床Hunt和Hess分级如下：Ⅰ级6例；Ⅱ级3例；Ⅲ级11例；Ⅳ级2例；Ⅴ级1例。急诊治疗组患者的GOS评分如下：GOSⅠ级18例；GOSⅡ、Ⅲ和Ⅳ级各1例；GOSⅤ级2例。该组有7例技术并发症，大多无症状，但1例患者在治疗期间动脉瘤破裂后死亡，1例在4个月时遗留复视。8例患者因偶然发现的基底动脉分叉部动脉瘤接受治疗。该组偶然发现动脉瘤的患者发生1例无神经功能缺损的技术并发症。94%的患者即刻血管造影结果被认为满意，42%完全闭塞，52%有残留颈部和“狗耳”。在3至42个月（29例存活患者平均15.5个月）的临床随访期内，治疗后无出血事件发生。6个月时27例患者有血管造影结果，情况如下：30%的病变完全闭塞，59%有一些残留颈部，11%动脉瘤囊有一些造影剂充盈。在长达42个月的随访期内，共发现7例复发，5例患者需要再次用GDC治疗。基底动脉分叉部动脉瘤的血管内治疗可预防再出血，94%的患者可在无临床显著并发症的情况下进行治疗。SAH后的临床结果与外科手术系列相比更具优势。形态学结果似乎不太令人满意，必须进行长期血管造影随访以检测复发情况。
