Post-embolization anatomy and clinical outcomes All patients with aneurysm embolization were treated with DSA, complete embolization, and anesthetized patients with complete embolization. The angiogenic images were reviewed half a year after embolization. The anatomical results were classified as follows: (1) complete embolization: no residual voids were found in each cerebral angiography projection position; (2) neck residual: the aneurysm neck showed partially unfilled voids; (3) not Complete tamponade: There is still contrast agent development in the aneurysm or tumor. Clinical follow-up was obtained through outpatient follow-up visits and telephone interviews. The clinical outcomes were classified according to Glasgowoutcomescale as follows: (1) recovery: no damage to nerve function; (2) improvement: hemoptysis, mild paralysis of cranial nerves or other neurological dysfunction Affect daily life; (3) General: hemiplegia is more serious, there are aphasia, severe neurological dysfunction, affecting daily life and work; (4) poor: coma, severe neurological deficit, need special care.
Postoperative treatment of puncture point pressure dressing, bed rest 6h brake, give antibiotics, hormone application 3d, have cerebral vasospasm, give relief, expansion treatment. The DSA was followed up for half a year and one year after surgery. In this group of patients, there were 4 kinds of technical operation complications, 1 case of perforation and rupture of aneurysm, 3 cases of cerebral ischemia (2 cases of cerebral arterial embolism, 1 case of cerebral vasospasm). 2 cases after embolization One side of cerebral ischemia and hemiplegia, conservative treatment after internal medicine, rehabilitation training, recovery after 3 months, neurological dysfunction disappeared, and another case of transient aphasia, the clinical treatment effect of this group showed 1 death, died of aneurysm rupture . After embolization, 11 of the aneurysms in this group reached complete infarction, 5 had residual tumor neck, and 2 had partial embolization. The clinical results showed 1 death, 3 mild neurological dysfunction, recovery after treatment, and 13 recovery, but further observation of its long-term effects.
GDC is a platinum micro-coil ring <14> developed by Italian-born American scholar Guglielmi in 1989. Since the application of GDC embolization in the treatment of aneurysms since 1990, it has been simple and safe to treat aneurysms via endovascular intervention. The application of GDC greatly reduces the possibility that the coil will escape to the blood supply artery (the tumor-bearing artery) to be blocked. Before the electrolytic release, the GDC can be completely controlled in the aneurysm until the filling is satisfactory, so that the treatment of the deep aneurysm Become safe and effective. In our work, we mainly consider the following aspects: (1) Due to the size and location of the tumor, it is estimated that the risk of surgical treatment is large, 13 cases are difficult to operate; (2) 1 case of failure to attempt surgical closure of aneurysm; (3) The physical condition is poor, there are 3 cases of serious medical complications and severe neurological conditions; (4) Those with better economic status, patients who are unwilling to undergo craniotomy are given priority to endovascular treatment. Comprehensive foreign interventional neurotherapy experts' opinions: (1) Modern GDC embolization treatment technology is a safe and effective clinical method. GDC can be said to be a fully controllable coil, which is incompletely controllable compared with MDS and balloon. Embolization materials are much safer; (2) most aneurysms can be successfully treated with GDC embolization. (3) Even if the aneurysm embolism in the acute phase is incomplete, it is also important to prevent the aneurysm from rupturing again. For patients with elective embolization, the aneurysm should be completely filled as much as possible; (4) GDC embolization still needs long-term follow-up; (5) GDC The micro-coil needs to be further improved in terms of bio-modification and deformability, so that the future GDC will be more rapid and stable, and it will do better in completely filling the aneurysm.
Precautions for embolization treatment 413.1 GDC coil selection The diameter of the first microcoil should be slightly smaller than the diameter of the embolization aneurysm so that the GDC can be fully deployed, but larger than the diameter of the neck to prevent GDC from coming off. The first micro-coil should be selected as a standard type so that the GDC fits snugly into the aneurysm. The spring ring to be filled in later should be a double-diameter or soft-type small spring coil; the first one of the spring ring can be selected to be longer, and the spring ring to be filled later should not be too long to prevent the micro-catheter port from being blocked. The key to GDC embolization is that the front end of the microcatheter must be accurately delivered into the aneurysm lumen as long as the tip of the microcatheter is placed into the aneurysm lumen. GDC can be deployed in the aneurysm and successfully fill the aneurysm. When placing the microcatheter, it is important to fix the guiding tube. The distal end of the guiding tube should be close to the skull base. The guiding tube should not be twisted and folded in the blood vessel. In this group, the guiding tube suddenly disappears when the catheter is twisted into the microcatheter. Stretching causes the microcatheter and microwire to suddenly penetrate the aneurysm, causing perforation of the aneurysm. In the endovascular interventional treatment of vasospasm, due to vascular puncture, catheter and guide wire repeatedly mechanical stimulation and repeated angiography in the blood vessels, cerebral vasospasm caused by contrast agent, in case of cerebral vasospasm, surgery should be terminated; When the catheter is not visible on the screen, the metal ring at the end of the microcatheter does not move, and it cannot be forcibly pulled out. The papaverine can be injected locally, and it can be slowly pulled out for treatment of expansion and antispasmodic treatment. The huge type of intracranial aneurysm often has a mass effect, but the occupancy effect of GDC embolization often disappears slowly, and the symptoms of peripheral nerve compression slowly improve and disappear. In this group, one patient with ptosis returned to normal after embolization. . For most wide-neck aneurysms, the balloon aneurysm often requires balloon or stent-assisted shaping, and the operation is complicated. This group is not involved, and further research is needed.
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