| Intracranial aneurysm is a very dangerous disease which can take great trouble to people. The rules of its occurrence, grow and prognosis are still ambiguous. As the hemodynamic factors have great relationship with aneurismal abiogenesis, it became the hotspot of aneurismal study in the world in recent years. We reviewed the aneurismal cases formerly, and summarized the artery image characteristics of intracranial familiar aneurysms(anterior communicating artery aneurysm and posterior communicating artery aneurysm); the familiar geometry fashiones of the two types of aneurysms were imported into the computer for simulation, then they were analysed by using finite element method and finally obtained corresponding hemodynamic datum. We still calculated the volume proportion for aneurismal endovascular embolization in clinical cases and designed the forecast program for aneurismal embolization by microcoils. So this study includes three parts:Part One: Clinical studies of intracranial familiar aneurysms Part Two: Computer simulation and finite element analyse of intracranialfamiliar aneurysmsPart Three: Clinical embolization effect's study and program's design for forecast of aneurismal embolization by microcoils Part OneObjectives: We reviewed the clinical cases' datum of AcoA.AN and PcoA.AN in our hospital, obtained the clinical representations, image characteristics in DSA and experiences of endovascular treatment in order to create conditions to finish computer simulation and finite element analyse, and provide clinical foundations.Methods: Collect 126 cases of AcoA.AN, and it accounts for 34.8% of the whole intracranial aneurysms in the corresponding period including 72 cases in male and 54 cases in female; age arrangement was from 26 to 64 yrs, average 47.48 yrs; male:female equals 1.3:1; 170 cases of non-AcoA.AN cases were chosen as the control group at random, including 94 cases in male and 76 cases in female and average 42.9 yrs old. Collect 107 cases of PcoA.AN, and it accounts for 29.56% of the whole intracranial aneurysms in the corresponding period including 42 cases with 43 aneurysms in male and age arrangement was from 25 to 76 yrs(average 44.62 yrs); 65 cases with 68 aneurysms in female and age arrangement was from 17 to 73 yrs(average 51.58 yrs); male:female equals 1: 1.55. All cases were proved by DSA, and treated by endovascular embolization using MDS or GDC tentatively. The unsuccessful embolized cases were treated by craniotomy or by follow-up. Results: 112 cases of all the AcoA.AN patients had ACA-A1 segment enlargement obviously in DSA image, and supplied the same side of ACA-A2 segment and the other side of hemisphere through AcoA and other ACA-A2 segment. Al segment in the other side were severe stenosis,occlusion or obliteration. This was called "there-branches artery sign". 14 cases were with the same diameter in ACA-A1, and most of the aneurysms directed to front-inner-up(57 cases) or front-inner-down(50 cases). 109 cases were embolized successfully; 97 aneurysms were 100% embolized; 12 cases in 95%~98% embolized. 17 cases failed in the interventional treatment, and 15 of them were treated by craniotomy. 2 patients didn't have any treatment for severe cerebral vascular spasm. 123 cases were cured. One died after intervention interference, and 2 recovered without any treatment.107 cases with PcoA.AN had 110 segments of 1C A siphon(one had two PcoA.AN in a siphon), including 41 segments in "C" form, 56 segments in "V" form, 0 segments in "S" form and 13 in "double curve" form. As C2 segments in "C" form and "V" form direct obliquely to back-upper, this study unite them to "oblique" form(97 segments). And C2 segment in "double curve" form appears parallel, we call it "parallel" form(13 segments). All aneurysms located in or near the most sinuosity place in Cl. 39 cases appeared oculomotor nerve paralysis. 107 cases had 111 PcoA.ANs. 104 cases were cured; 3 died(age 71/68/59 yrs old, Hunt-Hess IV grade). 29 aneurysms were embolized by MDS, 82 by GDC. The number of...
|
PDF Full Text Request