创伤性硬膜下假性动脉瘤的临床特点及治疗选择（附6例报道）

目的探讨创伤性硬膜下假性动脉瘤（TS-PSAN）的治疗方法选择及疗效。方法回顾性分析中国人民解放军联勤保障部队第九〇〇医院神经外科2016年1月—2021年12月收治的6例TS-PSAN患者的临床治疗。所有患者均通过头颅DSA明确诊断，4例行血管内治疗，其中2例闭塞载瘤动脉，2例双支架联合弹簧圈栓塞；1例患者行颅内外血管搭桥手术；1例保守治疗。术后随访8个月～6年。结果6例TS-PSAN外伤后均有蛛网膜下腔出血，5例首次CTA或DSA检查明确动脉瘤诊断，1例伤后第1次CTA阴性，因眼球充血肿胀，42 d后行CTA检查明确颅内巨大动脉瘤伴颈内动脉海绵窦瘘。6例患者动脉瘤均治愈，4例获得CTA随访，2例获得DSA随访，术后 6个月随访时改良Rankin量表评分0分2例，1分1例，2分3例。随访(33.95±13.86)个月内均无复发。结论应根据动脉瘤位置及形态，结合患者颅脑损伤的治疗策略选择最佳治疗方案，血管内治疗首选血管重建；代偿良好者或较末梢且不影响功能者，闭塞载瘤动脉是安全的；开颅手术同样是一项重要治疗方法。

Objective To investigate the treatment and efficacy of traumatic subdural pseudoaneurysm(TS-PSAN). Methods The clinical data of 6 patients with TS-PSAN admitted to Department of Neurosurgery, 900th Hospital of Joint Logistics Team of People's Liberation Army from January 2016 to December 2021 were analyzed retrospectively. All patients were diagnosed by DSA, 4 patients were treated with endovascular treatment, including 2 with parent artery occlusion and 2 with double stents combined with coil embolization. 1 patient underwent extracranial and intracranial bypass surgery. 1 was treated conservatively. Follow-up was performed from 8 months to 6 years. Results All 6 cases of TS-PSAN suffered tramatic subarachnoid hemorrhage. The diagnosis of aneurysm was confirmed by the first CTA or DSA in 5. The first CTA was negative in 1 after injury, 42 d later, due to eyeball hyperemia and swelling, the giant intracranial aneurysm with internal carotid cavernous sinus fistula was confirmed by CTA. All 6 patients were cured. Among them, 2 received DSA in the follow-up and the other 4 received CTA, and the modified Rankin scale scores was 0 in 2 patients, 1 in 1 patient,and 3 in 2 patients during the follow-up 6 months after operation. There were no recurrence cases during the follow-up of(33.95±13.86) months. Conclusions The optimum treatment plan should be modified according to the location and shape of the aneurysm. Vascular reconstruction is the first choice for endovascular treatment. It is safe to occlude the parent artery for those with good compensation or those peripheral vessels and no influence on the function. Craniotomy is also an important treatment.