目的 探讨三维数字减影血管造影(3D DSA)辅助下应用弹簧圈血管内栓塞治疗颅内微型动脉瘤的技术要点及疗效.方法 回顾性分析自2005年1月至2008年12月,23例颅内微型动脉瘤患者临床资料(瘤体最大径≤3.0 mm),全部经二维造影及三维重建,并行血管内介入治疗.结果 3D DSA在诊断此类动脉瘤方面最为精确,7例2D DSA定诊为阴性后,3D DSA检查发现动脉瘤,我们定义宽颈动脉瘤体颈比<1.5,2D DSA 为13例(81.3%),3D DSA 为11例(47.8%),在统计学上有显著差异(P<0.05);23例动脉瘤全部栓塞成功,其中致密栓塞7例,次全栓塞8例,部分栓塞8例,球囊辅助1例,支架辅助3例.术中颅内动脉瘤破裂出血3例,无死亡病例.脑血管造影复查5例,4例动脉瘤稳定,1例复发.所有患者随访中改良Rantin评分为0~1,生活可自理.结论 3D DSA在颅内微型动脉瘤的诊断和介入治疗中有重要的辅助作用,应用弹簧圈血管内栓塞治疗颅内微型动脉瘤疗效确切,术中微导管和弹簧圈技术是成功的关键.%Objective To investigate the techniques and effect of endovascular coiling of intracranial microaneurysms with the assistance of three-dimensional digital subtraction angiography (3D DSA).Methods A total of 23 cases of intracranial microaneurysms (maximal aneurysm diameter≤3.0 mm) treated with endovascular coiling between January 2005 and December 2008 were analyzed retrospectively. All cases were performed 2D and 3D angiography and intervention therapy. Results 3D DSA was more accurate in the detection of microaneurysms. Seven cases with negative 2D DSA result were found aneurysms with 3D DSA. As ratio of sac to neck (RSN) ＜ 1.5 was detined as "wide-neck" aneurysms, 13 (81.3％) aneurysms were wide-neck on 2D DSA compared with 11 (47.8％)on 3D DSA, with significantly statistical difference (P ＜0.05). Coil embolization was successfully pefformed in 23 cases including total embolization in 7 cases, subtotal embolization in 8 eases and partial embolization in 8 cases.Balloon assistance was used in 1 case and stent assistance in 3 cases. Rupture occurred during the operation in 3 eases but no dead case occurred. DSA follow-up in 5 cases demonstrated 4 persistent occlusions of the aneurysms and aneurysmal recurrence in 1 case. Modified Rankin Score (mRS) was 0 ～ 1 in 23 cases. Condusion 3D DSA may be a useful tool in the diagis and interventional treatment of intracranial microaneurysms. Coil embolization is effective in the treatment of microaneurysms, while microcatheter and coiling is essential for the embolization.
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