镜像动脉瘤发生影像学及治疗ppt课件.ppt

1 Genesis ImagingandTreatmentofIntracranialMirrorAneurysms MirANs InstituteofDiagnosticandInterventionalRadiology TheSixthAffiliatedPeople sHospital ShanghaiJiaoTongUniversity TANHUA QIAOMD Ph D 2 DefinitionofMirAN Uncommon specialsubgroupofmutipleintracranialaneurysms occuringatroughlythesamelocationoneachsideinthesamepatientwithoutconsideringthesizeoftheaneurysms 3 HypothesisongenesisandgrowthofMirANs Adifferentetiologicprocessoccursinmirroraneurysmdisease Acongenitalpredisposition andtheearlyembryologicalderangementofvascularwallformationmightbeoneoftheirunderlyingcauses EarlyruptureinpatientswithnoextrinsicriskfactorssupporttheroleofacongenitalpredispositionoverdegenerativecausesinthepatientswithMirAN Hemodynamicforcesmightberesponsiblefortriggeringthedevelopmentofananeurysmintheprimarilyabnormalvesselwall 4 EpidemiologyofMirANs Prevalence Constitutelessthan5 ofoverallaneurysmsAccountforapproximately20 30 amongmultipleaneurysmsFamilialandtwinintracranialaneurysm 65 70 Non familial sporadicintracranialaneurysm 21 Ourresultfrom190patientsharboringmutipleintracranialaneurysmsbetweenJune2007andJuly2011MANsaccountfor26 3 amongmultipleaneurysms 5 EpidemiologyofMirAN LocationCommonlocation MCAbifurcationandPCoAreportedbyliteratureUncommonsite ACAA1 Pericallosal VertebralArteryOurresultfrom50patientswithMirANbetweenJune2007andJuly2011MCAbifurcation 10 PCoA C7 24 C6 24 C5 20 C4 20 Otherlocation 2 6 EpidemiologyofMirANs GenderdistributionMirANVSnMirANswithmutipleintracranialaneurysms Female maleratio 3 1 1VS2 1 1Female maleratioofMirANsandnMirANsincreasedwiththeage60 yearsMirANsVSnMirANs 7 1VS9 1Ourresultfrom50patientswithMirANbetweenJune2007andJuly2011Female maleratio 2 3 1 7 EpidemiologyofMirANs Averageageatpresentation ruptureforMirANsandnMirANspatientswasinthe5thdecadeWomenpresentedlaterthanmeninMirANsandnMirANsOurresultfrom50patientswithMirANsMeanageofMirANspresentation 62 4 12 5yearsWomenvsMenforMirANs 62 1 12 3vs63 13 4 P 0 05 SAHoccurredin13of30intracranialMirAnpatients 43 3 AverageageofpatientswithrupturedMirANs 62 7 9 9 Casimiro MV etal SurgNeurol 2004 61 541 5 8 EpidemiologyofMirANs RiskfactorsCigaretteSmokingMeanageatpresentationforMirAnsvsnMirAns 53 3 9 1vs48 7 11 7PeakageofruptureforMirAnsvsnMirAns thestartofthe5thdecadevsthestartofthe6thdecadeHypertensionMeanageatpresentationinMirAnsvsnMirAns 58 7 9 2vs56 10 4Hypertensionwasthemostprevalentriskfactorinpatientspresentedafter60 yearsold 62 5 inMirAns and30 innMirAns P 0 05 NoknownextrinsicriskfactorsTheagepatternofpresentationandruptureweredifferentbetweenMirAnandnMirAnwithoutrecognizedriskfactors NoknownextrinsicriskfactorswasthemaincharacteristicofthesubsetofMirAnpatients 40years Casimiro MV etal SurgNeurol 2004 61 541 5 9 AgepatternofdiseasepresentationforthegeneralMirANpopulationandfortheriskfactors HBP Highbloodpressure S Cigarettesmoking andnRF Noknownextrinsicriskfactors 10 Agepatternofdiseasepresentationforthegeneralno MirANpopulationandfortheriskfactors HBP Highbloodpressure S Cigarettesmoking andnRF Noknownextrinsicriskfactors 11 RelativeprevalenceofeachriskfactorbyagegroupinMirAn HBP Highbloodpressure S Cigarettesmoking andnRF Noknownextrinsicriskfactors 12 RelativeprevalenceofeachriskfactorbyagegroupinnMirAn HBP Highbloodpressure S Cigarettesmoking andnRF Noknownextrinsicriskfactors 13 MirANsdiagnosisapproachesMRACTADSAMirANswereClassifiedas2type type completesymmetry type incompletesymmetry MirANsdiagnosisandclassification 14 IdentificationofdutylesiononMirANs CT MRIHematomasite themostthicksiteofSAHCTA MRA DSAAneurysmsizeAneurysmmorphologyParentarteryand oradjacentarteryspasm 15 typeMirANs 16 typeMirANs 17 Therapeuticdecision makingonMirANs WhetherintracranialunrupturedMirANsshouldbetreated Dependonthewellknownfactorssuchasageofthepatient localizationandsizeoftheaneurysm shouldbediscussedwiththeaffectedpatientonanindividualbasis Iftreatmentisconsidered whichchoiceoftreatmentshouldbeemployed surgicalclippingorendovascualrtreatment Dependonthelocationandaneurysmfeatures Iftreatmentisperformed theonestageoperationortwostageoperationwaschoose Thefirstchoiceisonestageoperation butifthepatientisnotsuitforonestageoperation thedutyaneurysmshouldbetreatedfirst 18 Case1M 64Y progressiveenlargementofincidentlyfoundaneurysm 19 Pre