Diagnosis And Treatment Of Intracranial Dissecting Aneurysm

Objective: Clinical studies on domestic intracranial dissecting aneurym(IDA) islittle. This study summarizes the nine cases of clinical data and experience in thetreatment of patients with IDA, explore their options and efficacy of endovasculartreatment program.Clinical data and methods: Between December2008to December2014in theSino-Japanese Friendship Hospital of Jilin University, a neurosurgery departmenttreated IDA9patients,6males and3females, aged31to62years, mean48.9yearsof age, a history of hypertension2cases, two cases of pulmonary infection, nosignificant history of head and neck trauma. The first clinical manifestations:headache seven cases, two cases of unconsciousness, convulsions two cases, twocases of dizziness, nausea and vomiting four cases, slurred speech, physical activityand other ischemic symptoms ineffective one case, convulsions, dizziness, headache,nausea and vomiting symptoms occupying one case. Were diagnosed by DSA or CTA.CT scan of the head, one case of head CT no subarachnoid hemorrhage, showingincreased sella, right behind the prominent, visible lumps high density and patchycalcification, bone destruction seen locally. The remaining eight patients showingsubarachnoid hemorrhage, Hunt-Hess grade Ⅱ grade6cases, grade Ⅲ2cases,including two cases of secondary rupture.DSA examination showed9patients hadvarying degrees of irregular narrow bureaucratic, including one case of dual-chamberangiography can show signs(contrast agent at the same time developing within thevessel lumen and wall hematoma), two-way blood flow, late arterial imagingcontrast agents retention within the mezzanine and other direct signs artery dissection.Nine cases in two cases fall within the carotid artery IDA, respectively, using a singlestent assisted coil embolization and occlusion balloon technique.7cases belong to thevertebral-basilar artery system IDA, IDA is located five cases in which the initialdistal PICA, two cases of IDA is located at the beginning part of PICA.Seven cases in one case the initial distal PICA IDA for economic reasons not to acceptendovascular surgery, the use of isolated cranial aneurysm surgery, two cases of distalPICA starting IDA and one case of PICA beginning part of the IDA are made simplecoil embolization, one case of distal PICA starting IDA single stent assisted coilembolization, one case of PICA beginning part of the IDA and one case of distalPICA starting IDA are double stent assisted coil embolization.Results:9cases of IDA in patients with isolated cranial aneurysm surgery onecase, a simple balloon occlusion technique one case, a simple coil occlusion in3cases,a single stent assisted coil embolization two cases, double stent assisted coilembolization2cases. Follow-up one month to six years, an average of8.1months.9patients were cured in six cases, one side of the basal ganglia infarction cases and2deaths.Treatment Effect9patients were cured in six cases, one side of the basal ganglia infarction casesand2deaths.1case of distal PICA starting IDA patients due to economic reasons, the familiesasked for cranial surgery isolated arterial dissection. A total of32days in hospital,after11days of hospitalization, at discharge, headache, nausea and vomitingsymptoms.2cases of distal PICA starting IDA give simple coil embolization. One patienthospitalized a total of two weeks, after one week of hospitalization, at discharge,headache disappear, no nausea, vomiting, convulsions. One case of total hospital oneweek, after five days of hospitalization, discharge head intermittent mild discomfort,no nausea, vomiting, convulsions.1case of distal PICA starting IDA given a single stent assisted coil embolization.Patients with a more than a month before the onset of slurred speech and a half to theright physical activity is not working, improved symptomatic treatment at a localhospital, in our hospital were hospitalized eight days, after five days of hospitalization,discharge private prosecution without dizziness, headache, slurred speech, musclestrength improved with the right limb, right limb muscle strength grade Ⅲ. 1case of the beginning part of IDA grant PICA double stent assisted coilembolization. A total of30days of hospitalization, postoperative hospital stay was21days. Discharge clear mind, speech is acceptable, no private prosecution headache, nonausea and vomiting.1case of the right internal carotid artery segment C2IDA given a single stentassisted coil embolization. A total of12days in hospital, after one week ofhospitalization. No private prosecution at discharge, headache, dizziness, nausea, novomiting, convulsions.1case of the right internal carotid artery cranio-cervical junction IDA givesimple balloon occlusion technique. A total of19days in hospital, after two weeks ofhospitalization. Preoperative45days to give Mata’s test (carotid compression test),no significant adverse reactions, Mata’s test results were negative. Intraoperativecarotid artery balloon occlusion test (BOT)20minutes, patients had no adversereaction, BOT test result was negative. The first day after surgery appear to the rightbasal ganglia infarction, left limb muscle strength grade Ⅲ. Discharge clear languageof God out, private prosecution was significantly reduced compared with the previousdizziness, headache, no seizures, no nausea, vomiting, left limb muscle strength gradeⅢ.1case of the beginning part of IDA grant PICA simple coil embolization. A totalof12days in hospital. Unconsciousness admission of patients with seizures, thesecond day after admission, total cerebral angiography, the third day runningventricular drainage, the eighth day IDA broken again, the eleventh day interventionalsurgery, patients generally poor state, ventilator-assisted breathing, deep coma, familymembers of patients after hospital discharge requirements for the second day, a monthafter the death of follow-up the patient was discharged.1case of distal PICA starting IDA grant dual stent assisted coil embolization.Patients admitted to hospital a month before the sudden dizziness, headache,13daysbefore admission, the above symptoms and accompanied by nausea, vomiting, headCTA outside the hospital diagnosed as IDA, ventricular drainage lines andsymptomatic treatment, the patient’s condition stable, before admission2IDA day again broken apnea patients, give emergency treatment, for the sake of furthertreatment in our hospital were hospitalized38days, Ninth day after admission givenstent assisted coil embolization, no significant improvement in patients,hydrocephalus, ventricular drainage line on the third day after surgery, the removal ofthe first24rows of the original ventricular drainage tube again ventricular drainage,postoperative hospital stay29days, family members of patients require dischargedback to the local hospital for further treatment. Follow-up of patients discharged fromhospital two months after the death.Conclusion: IDA early diagnosis, early treatment prognosis is good. Highmortality secondary rupture of IDA and disability, the prognosis is poor. IDAendovascular treatment for a safe and reliable method of treatment. Treatmentprograms should be based on clinical symptoms, IDA shape, location and OK.Comprehensive analysis of individual line endovascular treatment according to thepatient is very important.