Clinical Study Of Endovascular Interventional Treatment For Intracranial Posterior Circulation Aneurysms

Objectives:To study the technique and outcome of endovascular interventional treatment for cerebral aneurysms located in the posterior circulation, to evaluate the application of image examination in the diagnosis and follow-up of the aneurysms, to summarize the various kinds of means and main points of the embolization skills, and to analyze the prevention and treatment of the complications happened in the endovascular interventional treatment.Clinical data:From January 2004 to November 2008,23 patients with posterior circulation cerebral aneurysms were treated with endovascular interventional treatment. The data we got were analyzed retrospectively. In all the patients, there were 10 men and 13 women who aged from 35 to 72 years old with an average age 48. The Hunt-Hess grade at registration of the 23 patients was I in 3 patients,â…¡in 11,â…¢in 8,â…£in 1 patient. Subarachnoid hemorrhage were found in all cases, intraventricular hemorrhage in 10 and hydrocephalus in 8. After registration 4 aneurysms were found with CTA examination, 5 with MRA, and 23 intracranial posterior circulation aneurysms found with DSA in all the 23 cases. The 23 aneurysms consist of 8 located in the basilar artery,4 in the posterior cerebral artery,3 in the superior cerebellar artery,3 in the vertebral artery,5 in the posterior inferior cerebellar artery.3 of the aneurysms were small-sized (diameter< 0.6cm),14 were medium (0.6-1.5cm),5 were large (1.6-2.5cm), and 1 was giant (> 2.5cm). The percutaneous transfemoral catheterization under general anesthesia and GDC were applied in the coiling operations. In some cases, remodeling with balloon plus GDC or Neuroform combined with GDC were employed. The awareness at registration and the nervous conditions at discharge of the patients were analyzed.Results:Total occlusion in 20 cases were shown in angiography during operation, and occlusion beyond 90% shown in 3 cases. The aneurysm ruptured during operation in 1 case. Cerebral infarction in occipital lobe was found after operation in 1 case.1 patient with aneurysm located in the top bifurcation of basilar artery (Hunt-Hess gradeâ…£) dropped in continuous coma, and died of multiple organ failure. The other 20 patients recovered their ordinary work and life.21 patients were followed up from 6 months to 2 years. There was no rehaemorrhagia.9 patients accepted DSA and 1 was found partial visualization at the neck of the aneurysm who was coiled again.12 patients accepted MRA and 1 was found visualization at the neck, but the patient refused to accept the further treatment.Conclusion:It is microinvasive, safe and valid to apply with endovascular interventional treatment for cerebral aneurysms located in the posterior circulation. It is vital to coil the aneurysms in time for the improvement of the prognosis. To employ the correct technique and appropriate materials are the keys to improve the treatment quality. It is absolutely necessary to take advantage of various kinds of image methods for the diagnosis and post-operation follow-up. The careful operation is the important guarantee of the successful treatment. The perioperative treatment is also of great importance. And the recanalized aneurysm should be treated again.