镜像动脉瘤发生、影像学及治疗.ppt

*,*,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Genesis,Imaging and Treatment of Intracranial Mirror Aneurysms(,MirANs,),Institute of Diagnostic and Interventional Radiology,The Sixth Affiliated Peoples,Hospital,Shanghai,Jiao Tong University,TAN HUA-QIAO MD.Ph.D.,Definition of,MirAN,Uncommon,，,special subgroup of,mutiple,intracranial aneurysms;,occuring,at roughly the same location on each side in the same patient without considering the size of the aneurysms.,Hypothesis on genesis,and,growth of,MirANs,A different etiologic process occurs in mirror aneurysm disease.,A congenital predisposition,and the early embryological derangement of vascular wall formation might be one of their underlying causes.,Early rupture in patients with no extrinsic risk factors support the role of a congenital predisposition over degenerative causes in the patients with,MirAN,.,Hemodynamic,forces might be responsible for triggering the development of an aneurysm in the primarily abnormal vessel wall.,Epidemiology of,MirANs,Prevalence:,Constitute less than 5%of overall aneurysms,Account for approximately 20%30%among multiple,aneurysms,Familial and twin intracranial aneurysm:65,70%,Non-familial,sporadic intracranial aneurysm:,21%,Our result from 190 patients harboring,mutiple,intracranial aneurysms between June 2007 and July 2011,MANs,account for 26.3%among multiple aneurysms,Epidemiology of,MirAN,Location,Common location:,MCA bifurcation and,PCoA,reported by literature,Uncommon site:,ACA A1,Pericallosal,Vertebral,Artery,Our result from 50 patients with,MirAN,between June 2007 and July 2011,MCA bifurcation(10%),PCoA/C7(24%),C6(24%),C5(20%),C4(20%),Other location(2%),Epidemiology of,MirANs,Gender distribution,MirAN,VS,nMirANs,with,mutiple,intracranial aneurysms-,Female/male ratio:3.1:1 VS 2.1:1,Female/male ratio of,MirANs,and,nMirANs,increased with the age,60-years,MirANs,VS,nMirANs,:7:1 VS 9:1,Our result from 50 patients with,MirAN,between June 2007 and July 2011,Female/male ratio:2.3:1,Epidemiology of,MirANs,Average age at presentation/rupture for,MirANs,and,nMirANs,patients was in the 5,th,decade,Women presented later than men in,MirANs,and,nMirANs,Our result from 50 patients with,MirANs,Mean age of,MirANs,presentation,：,62.412.5 years,Women,vs,Men for,MirANs,：,62.112.3,vs,6313.4 (P0.05),SAH occurred in 13 of 30 intracranial,MirAn,patients(43.3%).,Average age of patients with ruptured,MirANs,:62.79.9,Casimiro,MV,，,et al .,Surg,Neurol,2004;61:5415,Epidemiology of,MirANs,Risk factors,Cigarette Smoking,Mean age at presentation for,MirAns,vs,nMirAns,:,53.39.1,vs,48.711.7,Peak age of rupture for,MirAns,vs,nMirAns,:the start of the 5th decade,vs,the start of the 6th decade,Hypertension,Mean age at presentation in,MirAns,vs,nMirAns:58.79.2,vs,5610.4,Hypertension was the most prevalent risk factor in patients presented after,60-years old;62.5%in,MirAns,and 30%in,nMirAns,(P0.05),No known extrinsic risk factors,The age pattern of presentation and rupture were different between,MirAn,and,nMirAn,without recognized risk factors.,No known extrinsic risk factors was,the main characteristic of the subset of,MirAn,patients 40 years.,Casimiro,MV,，,et al .,Surg,Neurol,2004;61:5415,Age pattern of disease presentation for the general,MirAN,population and for the risk factors,HBP=High blood pressure,S=Cigarette smoking,and,nRF,=No known extrinsic risk factors.,Age pattern of disease presentation for the general no-,MirAN,population and for the risk factors,HBP=High blood pressure,S=Cigarette smoking,and,nRF,=No known extrinsic risk factors.,Relative prevalence of each risk factor by age group in,MirAn,HBP=High blood pressure,S=Cigarette smoking,and,nRF,=No known extrinsic risk factors.,Relative prevalence of each risk factor by age group in,nMirAn,HBP=High blood pressure,S=Cigarette smoking,and,nRF,=No known extrinsic risk factors.,MirANs,diagnosis approaches,MRA,CTA,DSA,MirANs,were Classified as 2 type:,type:complete symmetry,type:incomplete symmetry,MirANs,diagnosis and classification,Identification of duty lesion on,MirANs,CT/MRI,Hematoma,site/the most thick site of SAH,CTA/MRA/DSA,Aneurysm size,Aneurysm morphology,Parent artery and/or adjacent artery spasm,type,MirANs,type,MirANs,Therapeutic decision-making on,MirANs,Whether intracranial,unruptured,MirANs,should be treated?,Depend on the well known factors such as age of the patient,localization and size of the aneurysm.,should be discussed with the affected patient on an individual basis.,If treatment is considered,which choice of treatment should be,employed,surgical clipping or,endovascualr,treatment?,Depend on the location and aneurysm features,If treatment is performed,the one stage operation or two,stage operation was choose.,The first choice is one stage operation,but if the patient is not,suit for one stage operation,the duty aneurysm should be,treated first,Case 1,M,64 Y,progressive enlargement of,incidently,found aneurysm,Pre-,embolization,Post-,embolization,Pre-,embolization,Post-,embolization,Case 2 F,57 Y,SAH,L,R,L,R,R,L,Pre-,embolization,Post-,embolization,L,L,Pre-,embolization,Post-,embolization,Thank you,