| Intracranial aneurysm is a common clinical disease of neurosurgery, and is the most common cause of subarachnoid hemorrhage, for 50%　-85%　of subarachnoid hemorrhage etiology, with a high mortality rate and morbidity. The location, size, shape, number, direction of growth, growth rate and symptoms of intracranial aneurysm has a great impact on clinical work. The complex intracranial aneurysms due mainly refers to the size of the aneurysms, the width of the aneurysm’s neck, the location of the aneurysm which made difficult to clinical treatment, that include the following:　giant aneurysms, wide-necked, fusiform, dissecting or irregularly shaped aneurysms, aneurysms located in the cavernous segment of the internal carotid artery, near the clinoids, aneurysms of the vertebrobasilar system, multiple intracranial aneurysms, these factors made great risks and challenges to the treatment of neurological surgery, the outcome could be fatal. In order to improve the treatment of complex intracranial aneurysms, this article will focus on the factors and distribution of complex intracranial aneurysms, to discuss the Plans of treatment and evaluate the efficacy of treatment.Chapter oneAnalysis of factors affecting the morphology and distribution of complex intracranial aneurysmsBackgroundFactors of complex intracranial aneurysm’s formation is complex and multifaceted. Atherosclerosis is the basis of intracranial aneurysm’s pathology. Age, sex, hypertension, high cholesterol, and diabetes are the factors which could affect the blood vessels and contribute to atherosclerosis, vascular degeneration. They are important factors in aneurysm formation. At Present, the research on the impact of intracranial aneurysm rupture factors shows that hemodynamic is the most significant affect. The hemodynamic of aneurysm depends on the morphological, the current study of aneurysm morphology as following main aspects:　size, Position, shape, height-width ratio, height-neck ratio, width-neck ratio, the ratio of aneurysm’s height to the diameter of the Parent artery of aneurysms, the angle between aneurysm and the neck Plane (angle of aneurysm), the angle between the Plane of aneurysm neck and the Parent artery (blood vessel angle) and so on. The risk of complex intracranial aneurysmal rupture, difficulty of treatment and effects are closely related to the morphological characteristics. Therefore, this chapter focuses on complex intracranial aneurysms morphological characteristics and distribution.ObjectiveExplore the factors affect the morphological characteristics and distribution of complex intracranial aneurysms.Methods410 Patients with complex intracranial aneurysms got a retrospective analysis which were collected from the department of neurosurgery, Zhujiang Hospital of Southern Medical University in recently 10 years.153 cases of males,257 cases of females, age range from 16-92 years old. Comprehensive analysis the relationship of multiple factors (gender, age, diabetes, hypertension, aneurysms’s location) in influencing complex intracranial aneurysm formation (size, aneurysm neck and morphology). Then, based on this analysis, explored the relationship between complex intracranial aneurysm’s size, neck and morphology. On the other hand, the patients were divided into two parts according to the age below 50’s and above 50 years old (include 50 years old), analyzed the differences of two groups, including gender, hypertension, diabetes, rupture or not, anterior circulation or posterior circulation. And then the logistic regression analysis methods was used to analyze these factors, to summarize the factors affecting of complex intracranial aneurysm. It’s divided into two parts according to the diameter below 10mm and above 10mm (include 10mm), analyzed the differences of two groups, including hypertension, diabetes, rupture or not, wide-neck or not, regular or irregular, anterior circulation or posterior circulation. And then the logistic regression analysis methods was used to analyze these factors, which affect the morphological and distribution characteristics of complex intracranial aneurysm.ResultsSex, age, aneurysm location were closely associated with the occurrence of wide-necked aneurysms. Location of anurysm is closely related to the size of the aneurysm. Age and location were closely associated with the shape of anurysms. There is significant differences between the two groups in gender (P<0.05), male under age fifty 46.11%, female under age fifty 53.89%; aged fifty and older, male 31.13%, female 68.87%. There is significant differences between the two groups in hypertension (P＜0.05), patients under age fifty with hypertension 19.9%, patients aged fifty and older with hypertension 45.1%. There is significant differences between the two groups in diabetes (P<0.05), patients under age fifty with diabetes 2.1%, patients age fifty and older with diabetes 6.3%. There is no differences between the two groups in ruptured (P=0.711) and position (P=0.058), patients under age fifty with ruptured 20.73%, patients aged fifty and older with ruptured 22.18%. There is no differences between the two groups of under 10mm and over 10mm (include 10mm) with hypertension (P=0.607) and diabetes (P=0.696). There is significant differences between the two groups of under 10mm and over 10mm (include 10mm) in ruptured (85.76%,58.33%; P<0.05), irregular shape (68.9%,50.9%; P<0.05), wide-neck (45.03%,25.93%; P<0.05). There is significant differences between the two groups of under 10mm and over 10mm (include 10mm) at difference position (P<0.05). There is significant differences between the two groups of wide-neck or not wide-neck in age (P<0.05, most aged over fifties), position (P<0.05, most happened at posterior communicating artery, internal carotid artery, middle cerebral artery). There is significant differences between the two groups of regular and irregular shape with hypertension (P＜0.05). There is significant differences between the two groups of regular and irregular shape at different position (P<0.05), most happened at middle cerebral artery, posterior communicating artery.ConclusionThe factors of aged, female patients, diabetes, hypertension may affect the structure of the brain vascular degeneration, leading to increased risk of complex aneurysms occur. Hypertension and diabetes did not significantly affect complex aneurysms’size. Complex intracranial aneurysms’morphology less than 10mm is more complex than the larger one, and is more likely to be rupture and bleeding. Anurysms at thinner artery were easier to be ruptured than the anurysms at thicker artery. Wide-neck anurysms is closely associated with age and the arteries with complex hemodynamics and large blood flow volume. The irregular anurysms were more likely occurred at thinner artery than the thicker one.Chapter twoEndovascular treatment of complex intracranial aneurysms BackgroundThere are two methods to treat intracranial aneurysms:　clipping and endovascular treatment. In the early, endovascular treatment was just as an assistant tech, but with the rapid development of neuroradiology, catheter technology, materials and computers, endovascular technology got matured. With its advantage of minimally invasive, fewer complications and quick recovery, the technology of endovascular embolization and become an important treatment for cerebrovascular disease. However, because of the complex morphology of complex intracranial aneurysms, complicated relationship with the surrounding structures, it also brings some difficulties to endovascular treatment. Although, in recent years, soft and safe stent delivery system made the stent may go through tortuosity vessel of the skull base, thus made aneurysm neck remodeling Possible. The use of stent technology has changed the situation of low rate of dense embolization and Poor efficacy by using coil therapy only, which made interventional radiology treatment in such complex intracranial aneurysms become Possible, and the advantage is increasingly clear. But there are certain limitations factors that still need to overcome which made us continue to accumulate and summarize experience.ObjectiveTo investigate the methods selection of complex intracranial aneurysms treatment and curative effect.Methods410 Patients with complex intracranial aneurysms got a retrospective analysis which were collected from the department of neurosurgery, Zhujiang Hospital of Southern Medical University in recently 10 years.153 cases of males,257 cases of females, age range from 16-92 years old. Comprehensive analysis the differences of therapeutic effect, recurrence and prognosis in different treatment methods (simply aneurysm embolization, stent-assisted embolization, surgical clipping). Patients got endovascular treatment were divided into two groups, merely coil embolized and stent-assisted. Analysis the two groups’ embolism degree and curative effect in wide-neck or not, regular shape or not, big size or not.ResultsThere is no obviously difference between the simply aneurysm embolization, stent-assisted embolization, surgical clipping at therapeutic effect, recurrence and prognosis with anurysms’ neck, shape and size. There are 311 Patients with complex intracranial aneurysms got endovascular treatment,256 patients with merely coil embolized,55 patients with stent-assisted. Patients with merely coil embolized had been cured 89.06%, death 4.69%; Patients with stent-assisted had been cured 90.90%, death 9.09%. Patients with complex intracranial aneurysms in wide-neck had been cured 86.5%, stent-assisted 87.0%, not wide-neck had been cured 87.0%, there is no significance difference (P=0.306). Patients with complex intracranial aneurysms in regular shape had been cured 84.2%, patients with complex intracranial aneurysms in irregular shape had been cured 88.0%, there is no significance difference (P=0.127). Complex intracranial aneurysms’ diameter less than 10mm had been cured 87.0%, larger than 10mm 86.2%, without significance difference (P=0.834). Complex intracranial aneurysms’ diameter over 10mm with merely coil embolized had been dense embolized 48.5%, group with stent-assisted had been dense embolized 60%, there is no significance difference (P=0.720); merely coil embolized group been cured 91.2%, stent-assisted group been cured 86.7%, no significance difference (P=0.179); merely coil embolized group relapsed 5.5%, stent-assisted group relapsed 5.1%, no significance difference (P=0.945). The wide-neck aneurysms with merely coil embolized had been dense embolized 47.8%, group with stent-assisted had been dense embolized 48.8%, there is no significance difference (P=0.494); merely coil embolized group been cured 93.8%, stent-assisted group been cured 90.7%, no significance difference (P=0.541); merely coil embolized group relapsed 3.1%, stent-assisted group relapsed 5.1%, no significance difference (P=0.610) Irregular shape aneurysms with merely coil embolized had been dense embolized 41.2%, group with stent-assisted had been dense embolized 37.5%, there is no significance difference (P=0.403); merely coil embolized group been cured 95.1%, stent-assisted group been cured 95.8%, no significance difference (P=0.868); merely coil embolized group relapsed 5.0%, stent-assisted group relapsed 13.0%, no significance difference (P=0.121)ConclusionStent can reduce the relaps of giant anurysms, improve dense embolization.Stent can proteced the operation of wide-neck and irregular anurysms.Complex aneurysm treatment is individualized, depending on the width of the neck of the aneurysm, arterial aneurysm morphology, direction, the relationship with the parent artery aneurysm. The stent-assisted technique for the complex aneurysm embolization is helpful, but it must selected the suitable treatment in specific conditions of aneurysm. The key point is to block the aneurysm’s neck, change the hemodynamic of aneurysm. |
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