颅内常见动脉瘤的血液动力学研究及动脉瘤微弹簧栓塞预测程序的研制
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摘要
颅内动脉瘤是一种严重危害人类生命安全的疾病，其发生、发展和转归的规律仍未完全明确。在各种影响因素中，血液动力学因素与该病的自然发生史密切相关，因而近年来成为国内外研究的热点。本研究通过对既往病例的总结，得出颅内常见动脉瘤(前交通动脉瘤和后交通动脉瘤)的血管影像特点；同时将这两种动脉瘤的常见几何模式引入计算机模拟，并行有限元计算分析，得出相应的血液动力学数据；在总结临床病例的同时归纳了动脉瘤血管内栓塞治疗时的体积栓塞比例，并将该比例应用于颅内动脉瘤微弹簧栓塞预测程序的研制。因此，本研究包括三个部分，即：
第一部分：颅内常见动脉瘤的临床研究
第二部分：颅内常见动脉瘤的计算机模拟与有限元分析
第三部分：临床栓塞治疗效果研究及动脉瘤微弹簧栓塞预测程序的研制
第一部分
目的
总结我院收治的前交通动脉瘤和后交通动脉瘤临床病例，得出这两种动脉瘤的发病规律、DSA影像特点和介入治疗体会，为下一步进行计
算机模拟和有限元分析创造条件，提供临床支持依据。
方法
l陆床收集前交通动脉瘤病例126例，占同期全部颅内动脉瘤病例的
34.8%。其中，男性72例，女性54例，年龄26一64岁，平均47.48岁;
男女比1.3:l。同时，随机选取170例非前交通动脉瘤脑血管造影病例
作为对照，男94例，女76例，平均年龄42.9岁。
临床收集后交通动脉瘤病例107例，占同期全部颅内动脉瘤病例的
29.56%。其中，男性42例43个，年龄25一76岁，平均44.62岁;女性
65例68个，年龄17一73岁，平均51.58岁;男女比l:1.55。
全部病例均经数字减影血管造影(DSA)检查证实，并尝试应用MDS
或GDC进行血管内栓塞治疗，未能成功栓塞治疗的病例行开颅手术治疗
或进行临床观察。
结果
1 26例前交通动脉瘤中，DSA造影提示:112例为病灶侧大脑前动脉
Al段明显增粗，通过前交通动脉分为双侧A2供应两侧大脑半球，对侧
Al纤细、闭塞或缺如，即明确的“三分叉动脉征”;14例为双侧Al基本
对称，
内上前
病灶无明确的优势供血，亦无“三分叉动脉征”。瘤体指向主要为
(57例)和内下前
成功栓塞109例，其中
(50例)。
100%闭塞97例，95%一98%闭塞12例。17例
因微导管不能到位而未能成功栓塞，其中巧例择期行开颅手术夹闭瘤
颈。2例因较严重的脑血管痉挛放弃栓塞及手术治疗。123例治疗后痊愈，
1例行血管内栓塞后死亡，2例动脉瘤自愈。
107例后交通动脉瘤包括110段颈内动脉虹吸部(l例为同侧后交通
动脉瘤)，其中，“C，，型41段、“V，，型56段、“S”型0段、“双弯”
型13段。因“C”型、“V”型的C2段均呈斜行后上方向，故本研究将
其合并称为“斜型”，合计为97段，“双弯”型C2段呈水平形，故称
一3一
为“水平型”，合计为13段。无论“斜型”还是“水平型”，动脉瘤均
处于或接近于C1段最大弯曲处。39例出现动眼神经麻痹症状。
107例In个后交通动脉瘤，104例痊愈，3例死亡(年龄分别为71
岁、68岁、59岁，Hunt一HesS分级均为IV级)。用姻S治疗29个，GDC
治疗82个。MDS数最多4个，最少1个，平均2.93;Goc最多8个，最
少1个，平均3.41个。DSA影像上达到100%栓塞95个，95%栓塞12个，
90%栓塞4个。
结论
颅内动脉瘤主要发生于中老年人，前交通动脉瘤和后交通动脉瘤是
最常见的两种情况。
多数前交通动脉瘤患者的DSA影像呈明显的特征性变化，即出现“三
分叉动脉征”。双侧大脑前动脉的发育不均衡是形成前交通动脉瘤的危险
因素，与前交通动脉瘤的发生有密切的相关性，出现“三分叉动脉征”
的患者，形成前交通动脉瘤的几率非常大。
发生后交通动脉瘤的患者，其ICA一C2段主要呈“斜型”，少数呈
“水平型”，而这两种情况下的动脉瘤均处于或接近于C1段最大弯曲处
及血流直接冲击的区域。
因此，颅内动脉的局部解剖异常是动脉瘤发生的基础，血液动力学
因素则是动脉瘤发生的催化剂。
第二部分
目的
建立不同几何模式的前交通动脉和前交通动脉瘤、后交通动脉和后
交通动脉瘤有限元模型，加载不同的血流动力学参数，计算得到载瘤动
脉和动脉瘤的整体或局部受力情况及血流分布，观察其内在规律性。
方法
根据临床总结的DSA造影特点，结合文献，分别建立八种前交通动
一4一
脉复合体模式和十二种颈内一后交通动脉模式，以其中五种前交通动脉复
合体模式和四种颈内一后交通动脉模式为基础，分别设计不同深径比和体
径比的七种动脉瘤形态。建立上述几何形状的有限元模型后，加载相应
的物理参数，并进行运算。
结果
当血流速度较低的时候，不同AcoAC几何形状的AcoA远侧壁最大受
力数值无明显差别;随着血流速度的不断增加，其数值呈几何倍数增加，
AcoAC几何形状对AcoA远侧壁最大受力的影响也越来越大，这种变化尤
其在存在一侧ACA一Al增粗的几何模式下(IV型、V型
Intracranial aneurysm is a very dangerous disease which can take great trouble to people. The rules of its occurrence, grow and prognosis are still ambiguous. As the hemodynamic factors have great relationship with aneurismal abiogenesis, it became the hotspot of aneurismal study in the world in recent years. We reviewed the aneurismal cases formerly, and summarized the artery image characteristics of intracranial familiar aneurysms(anterior communicating artery aneurysm and posterior communicating artery aneurysm); the familiar geometry fashiones of the two types of aneurysms were imported into the computer for simulation, then they were analysed by using finite element method and finally obtained corresponding hemodynamic datum. We still calculated the volume proportion for aneurismal endovascular embolization in clinical cases and designed the forecast program for aneurismal embolization by microcoils. So this study includes three parts:
Part One: Clinical studies of intracranial familiar aneurysms Part Two: Computer simulation and finite element analyse of intracranial
familiar aneurysms
Part Three: Clinical embolization effect's study and program's design for forecast of aneurismal embolization by microcoils Part One
Objectives: We reviewed the clinical cases' datum of AcoA.AN and PcoA.AN in our hospital, obtained the clinical representations, image characteristics in DSA and experiences of endovascular treatment in order to create conditions to finish computer simulation and finite element analyse, and provide clinical foundations.
Methods: Collect 126 cases of AcoA.AN, and it accounts for 34.8% of the whole intracranial aneurysms in the corresponding period including 72 cases in male and 54 cases in female; age arrangement was from 26 to 64 yrs, average 47.48 yrs; male:female equals 1.3:1; 170 cases of non-AcoA.AN cases were chosen as the control group at random, including 94 cases in male and 76 cases in female and average 42.9 yrs old. Collect 107 cases of PcoA.AN, and it accounts for 29.56% of the whole intracranial aneurysms in the corresponding period including 42 cases with 43 aneurysms in male and age arrangement was from 25 to 76 yrs(average 44.62 yrs); 65 cases with 68 aneurysms in female and age arrangement was from 17 to 73 yrs(average 51.58 yrs); male:female equals 1: 1.55. All cases were proved by DSA, and treated by endovascular embolization using MDS or GDC tentatively. The unsuccessful embolized cases were treated by craniotomy or by follow-up. Results: 112 cases of all the AcoA.AN patients had ACA-A1 segment enlargement obviously in DSA image, and supplied the same side of ACA-A2 segment and the other side of hemisphere through AcoA and other ACA-A2 segment. Al segment in the other side were severe stenosis,
occlusion or obliteration. This was called "there-branches artery sign". 14 cases were with the same diameter in ACA-A1, and most of the aneurysms directed to front-inner-up(57 cases) or front-inner-down(50 cases). 109 cases were embolized successfully; 97 aneurysms were 100% embolized; 12 cases in 95%~98% embolized. 17 cases failed in the interventional treatment, and 15 of them were treated by craniotomy. 2 patients didn't have any treatment for severe cerebral vascular spasm. 123 cases were cured. One died after intervention interference, and 2 recovered without any treatment.
107 cases with PcoA.AN had 110 segments of 1C A siphon(one had two PcoA.AN in a siphon), including 41 segments in "C" form, 56 segments in "V" form, 0 segments in "S" form and 13 in "double curve" form. As C2 segments in "C" form and "V" form direct obliquely to back-upper, this study unite them to "oblique" form(97 segments). And C2 segment in "double curve" form appears parallel, we call it "parallel" form(13 segments). All aneurysms located in or near the most sinuosity place in Cl. 39 cases appeared oculomotor nerve paralysis. 107 cases had 111 PcoA.ANs. 104 cases were cured; 3 died(age 71/68/59 yrs old, Hunt-Hess IV grade). 29 aneurysms were embolized by MDS, 82 by GDC. The number of
第一部分：颅内常见动脉瘤的临床研究
第二部分：颅内常见动脉瘤的计算机模拟与有限元分析
第三部分：临床栓塞治疗效果研究及动脉瘤微弹簧栓塞预测程序的研制
第一部分
目的
总结我院收治的前交通动脉瘤和后交通动脉瘤临床病例，得出这两种动脉瘤的发病规律、DSA影像特点和介入治疗体会，为下一步进行计
算机模拟和有限元分析创造条件，提供临床支持依据。
方法
l陆床收集前交通动脉瘤病例126例，占同期全部颅内动脉瘤病例的
34.8%。其中，男性72例，女性54例，年龄26一64岁，平均47.48岁;
男女比1.3:l。同时，随机选取170例非前交通动脉瘤脑血管造影病例
作为对照，男94例，女76例，平均年龄42.9岁。
临床收集后交通动脉瘤病例107例，占同期全部颅内动脉瘤病例的
29.56%。其中，男性42例43个，年龄25一76岁，平均44.62岁;女性
65例68个，年龄17一73岁，平均51.58岁;男女比l:1.55。
全部病例均经数字减影血管造影(DSA)检查证实，并尝试应用MDS
或GDC进行血管内栓塞治疗，未能成功栓塞治疗的病例行开颅手术治疗
或进行临床观察。
结果
1 26例前交通动脉瘤中，DSA造影提示:112例为病灶侧大脑前动脉
Al段明显增粗，通过前交通动脉分为双侧A2供应两侧大脑半球，对侧
Al纤细、闭塞或缺如，即明确的“三分叉动脉征”;14例为双侧Al基本
对称，
内上前
病灶无明确的优势供血，亦无“三分叉动脉征”。瘤体指向主要为
(57例)和内下前
成功栓塞109例，其中
(50例)。
100%闭塞97例，95%一98%闭塞12例。17例
因微导管不能到位而未能成功栓塞，其中巧例择期行开颅手术夹闭瘤
颈。2例因较严重的脑血管痉挛放弃栓塞及手术治疗。123例治疗后痊愈，
1例行血管内栓塞后死亡，2例动脉瘤自愈。
107例后交通动脉瘤包括110段颈内动脉虹吸部(l例为同侧后交通
动脉瘤)，其中，“C，，型41段、“V，，型56段、“S”型0段、“双弯”
型13段。因“C”型、“V”型的C2段均呈斜行后上方向，故本研究将
其合并称为“斜型”，合计为97段，“双弯”型C2段呈水平形，故称
一3一
为“水平型”，合计为13段。无论“斜型”还是“水平型”，动脉瘤均
处于或接近于C1段最大弯曲处。39例出现动眼神经麻痹症状。
107例In个后交通动脉瘤，104例痊愈，3例死亡(年龄分别为71
岁、68岁、59岁，Hunt一HesS分级均为IV级)。用姻S治疗29个，GDC
治疗82个。MDS数最多4个，最少1个，平均2.93;Goc最多8个，最
少1个，平均3.41个。DSA影像上达到100%栓塞95个，95%栓塞12个，
90%栓塞4个。
结论
颅内动脉瘤主要发生于中老年人，前交通动脉瘤和后交通动脉瘤是
最常见的两种情况。
多数前交通动脉瘤患者的DSA影像呈明显的特征性变化，即出现“三
分叉动脉征”。双侧大脑前动脉的发育不均衡是形成前交通动脉瘤的危险
因素，与前交通动脉瘤的发生有密切的相关性，出现“三分叉动脉征”
的患者，形成前交通动脉瘤的几率非常大。
发生后交通动脉瘤的患者，其ICA一C2段主要呈“斜型”，少数呈
“水平型”，而这两种情况下的动脉瘤均处于或接近于C1段最大弯曲处
及血流直接冲击的区域。
因此，颅内动脉的局部解剖异常是动脉瘤发生的基础，血液动力学
因素则是动脉瘤发生的催化剂。
第二部分
目的
建立不同几何模式的前交通动脉和前交通动脉瘤、后交通动脉和后
交通动脉瘤有限元模型，加载不同的血流动力学参数，计算得到载瘤动
脉和动脉瘤的整体或局部受力情况及血流分布，观察其内在规律性。
方法
根据临床总结的DSA造影特点，结合文献，分别建立八种前交通动
一4一
脉复合体模式和十二种颈内一后交通动脉模式，以其中五种前交通动脉复
合体模式和四种颈内一后交通动脉模式为基础，分别设计不同深径比和体
径比的七种动脉瘤形态。建立上述几何形状的有限元模型后，加载相应
的物理参数，并进行运算。
结果
当血流速度较低的时候，不同AcoAC几何形状的AcoA远侧壁最大受
力数值无明显差别;随着血流速度的不断增加，其数值呈几何倍数增加，
AcoAC几何形状对AcoA远侧壁最大受力的影响也越来越大，这种变化尤
其在存在一侧ACA一Al增粗的几何模式下(IV型、V型
Intracranial aneurysm is a very dangerous disease which can take great trouble to people. The rules of its occurrence, grow and prognosis are still ambiguous. As the hemodynamic factors have great relationship with aneurismal abiogenesis, it became the hotspot of aneurismal study in the world in recent years. We reviewed the aneurismal cases formerly, and summarized the artery image characteristics of intracranial familiar aneurysms(anterior communicating artery aneurysm and posterior communicating artery aneurysm); the familiar geometry fashiones of the two types of aneurysms were imported into the computer for simulation, then they were analysed by using finite element method and finally obtained corresponding hemodynamic datum. We still calculated the volume proportion for aneurismal endovascular embolization in clinical cases and designed the forecast program for aneurismal embolization by microcoils. So this study includes three parts:
Part One: Clinical studies of intracranial familiar aneurysms Part Two: Computer simulation and finite element analyse of intracranial
familiar aneurysms
Part Three: Clinical embolization effect's study and program's design for forecast of aneurismal embolization by microcoils Part One
Objectives: We reviewed the clinical cases' datum of AcoA.AN and PcoA.AN in our hospital, obtained the clinical representations, image characteristics in DSA and experiences of endovascular treatment in order to create conditions to finish computer simulation and finite element analyse, and provide clinical foundations.
Methods: Collect 126 cases of AcoA.AN, and it accounts for 34.8% of the whole intracranial aneurysms in the corresponding period including 72 cases in male and 54 cases in female; age arrangement was from 26 to 64 yrs, average 47.48 yrs; male:female equals 1.3:1; 170 cases of non-AcoA.AN cases were chosen as the control group at random, including 94 cases in male and 76 cases in female and average 42.9 yrs old. Collect 107 cases of PcoA.AN, and it accounts for 29.56% of the whole intracranial aneurysms in the corresponding period including 42 cases with 43 aneurysms in male and age arrangement was from 25 to 76 yrs(average 44.62 yrs); 65 cases with 68 aneurysms in female and age arrangement was from 17 to 73 yrs(average 51.58 yrs); male:female equals 1: 1.55. All cases were proved by DSA, and treated by endovascular embolization using MDS or GDC tentatively. The unsuccessful embolized cases were treated by craniotomy or by follow-up. Results: 112 cases of all the AcoA.AN patients had ACA-A1 segment enlargement obviously in DSA image, and supplied the same side of ACA-A2 segment and the other side of hemisphere through AcoA and other ACA-A2 segment. Al segment in the other side were severe stenosis,
occlusion or obliteration. This was called "there-branches artery sign". 14 cases were with the same diameter in ACA-A1, and most of the aneurysms directed to front-inner-up(57 cases) or front-inner-down(50 cases). 109 cases were embolized successfully; 97 aneurysms were 100% embolized; 12 cases in 95%~98% embolized. 17 cases failed in the interventional treatment, and 15 of them were treated by craniotomy. 2 patients didn't have any treatment for severe cerebral vascular spasm. 123 cases were cured. One died after intervention interference, and 2 recovered without any treatment.
107 cases with PcoA.AN had 110 segments of 1C A siphon(one had two PcoA.AN in a siphon), including 41 segments in "C" form, 56 segments in "V" form, 0 segments in "S" form and 13 in "double curve" form. As C2 segments in "C" form and "V" form direct obliquely to back-upper, this study unite them to "oblique" form(97 segments). And C2 segment in "double curve" form appears parallel, we call it "parallel" form(13 segments). All aneurysms located in or near the most sinuosity place in Cl. 39 cases appeared oculomotor nerve paralysis. 107 cases had 111 PcoA.ANs. 104 cases were cured; 3 died(age 71/68/59 yrs old, Hunt-Hess IV grade). 29 aneurysms were embolized by MDS, 82 by GDC. The number of
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19． Burleson AC. Identification of quantifiable hemodynamic factors in the assessment of cerebral aneurysm behavior.(On behalf of the subcommittee on Biorheology of the Scientific and Standardization Committee of the ISTH). Thromb Haemost, 1996, 76:118-123．
20． Burleson AC, Strother CM, Turitto VT. Computer modeling of intracranial saccular and lateral aneurysms for the study of their hemodynamics, Neurosurgery, 1995; 37: 774-784．
21． Perktold K, Kenner T, Hilbert D, et al. Numerical blood flow analysis: arterial bifurcation with a saccular aneurysum, Basic Res. in Cardiology, 1998; 83: 24-31．
22． Perktold K, Peter R, Resch M. Pulsatile nonnewtonian blood flow simulation through a bifurcation with an aneurysm. Biorheology, 1991, 26: 1011-1030．
23． Low M, Perktold K, Raunig R. Hemodynamics in rigid and distensible saccular aneurysms: A numerical study of pulsatile flow characteristics. Biorheology, 1993, 30: 287-298．
24． Hayashi K, Handa H, Nagasawa S. Stiffness and elastic behavior of human intracranial and extracranial arteries. J Biomechanics, 1980, 13: 175-184．
25． Foutrakis GN, Yonas H, Sclabassi RJ. Saccular aneurysm formation in curved and bifuracation arteries. AJNR, 1999, 20:1309-1317．
26． Liepsch DW, Steiger HJ, Poll A. Hemodynamic stress in lateral saccular aneurysms. Biorheology, 1987, 24: 689-710．
27． Gonzalez CF, Cho YL, Ortega HV. Intracranial aneurysms: Flow analysis of their origin and progression. AJNR, 1992, 13 :181-188．
28． Ujiie H, Liepsch DW, Goetz M, et al. Hemodynamic study of the anterior communicating artery. Stroke, 1996, 27:2086-2094．
29． Steiger HJ, Poll A, Liepsch DW. Basic flow structure in saccular aneurysms: a flow visualization study. Heart Vessels, 1987, 3:55-65．
30． Yamaguchi R. Distribution of mass transfer rate and wall shear stress behind simple rectangular stenosis in pulsating flow. J Biomech Eng, 1989,111:47-54．
31． Liepsch DW. Flow in tubes and arteries: a comparison. Biorheology, 1986, 23:395-433．
32． Griffith TM, Edwards DH, Davies RL. EDRF coordinates the behaviour ofvascular resistance vessels. Nature, 1987, 329:442-445．
33． Moncada S, Palmer RMJ, Higgs EA. Nitric oxide: physiology, pathophysiology and pharmacology. Pharmacol Rev, 1991, 43:109-142．
34． Levesque MJ, Liepsch DW, Moravec S. Correlation of endothelial cell shape and wall shear stress in a stenosed dog aorta. Arteriosclerosis, 1986, 6:220-229．
35． Rossitti S, Loefgren J. Vascular dimensions of the cerebral arteries follow the principle of minimum work. Stroke, 1993, 24:371-377．
36． 黄勤，付万新，柳浩然。前交通动脉复合体的解剖学研究。中华神经 医学杂志，2002，1(1) ：14～17。
37． Kirgis HD, Frsher WL, Liewellyn RC, et al. Aneurysm of the anterior communicating artery and gross anatomy of the circle of willis. J Neurosurg, 1966, 25(1) : 73．
38． 凌锋，李铁林，鲍玉海。介入神经放射影像学。北京：人民卫生出
版社，1999，261～280。
39． Eskridge JM, Song JK. Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils: results of the Food and Drug Administration multicenter clinical trial. J Neurosurg, 1998, 89:81-86．
40． Amagasaki K, Yagishita T, Yagi S, et al. Serial angiography and endovascular treatment of dissecting aneurysms of the anterior cerebral and vertebral arteries. Case report. J Neurosurg, 1999, 91(4) :682-686．
41． Vespa PM, Gobin YP. Endovascular treatment and neurointensive care of ruptured aneurysms. Crit Care Clin, 1999, 15(4) :667-684．
42． Murayama Y, Suzuki Y, Viuela F, et al. Development of a biologically active Guglielmi detachable coil for the treatment of cerebral aneurysms. Part Ⅰ: in vitro study. AJNR Am J Neuroradiol, 1999, 20(10) :1986-1991．
43． 刘承基。脑血管外科学。南京：江苏科学技术出版社，2000，67～75。
44． Cekirge HS, Islak C, Firat MM, et al. Endovascular coil embolization of residual or recurrent aneurysms after surgical clipping. Acta Radiol, 2000, 41(2) :111-115
45． Pruvo JP, Leclerc X, Ares GS, et al. Endovascular treatment of ruptured intracranial aneurysms. J Neurol, 1999, 246(4) :244-249．
46． Moret J, Ross IB, Weill A, et al. The retrograde approach: a consideration for the endovascular treatment of aneurysms. AJNR Am J Neuroradiol, 2000, 21(2) :262-268．
47． Malek AM, Halbach W, Phatouros CC, et al. Balloon-assist technique for endovascular coil embolization of geometrically difficult intracranial aneurysms. Neurosurgery, 2000, 46(6) : 1397-1407．
48． Lempert TE, Malek AM, Halbach VV, et al. Endovascular treatment of ruptured posterior circulation cerebral aneurysms. Clinical and
angiographic outcomes. Stroke, 2000, 31(1) :100-110．
49． Jizong Z, Shuo W, Jingsheng L. Combination of intraoperative embolization with surgical resection for treatment of giant cerebral arteriovenous malformations. J Clin Neurosci, 2000, 7 (1) : 54-59．
50． 张友平，吴中学，孙永权。经Mata’s压颈试验颈内动脉瘤自行闭塞 三例。中华神经外科杂志，1995，11(增刊)：60。
51． King WA, Martin NA. Critical care of patients with subarachnoid hemorrhage. Neurosurg Clin N Am, 1994,5(4) :767-787．
52． Stiver SI, Porter PJ, Willinsky RA. Acute human histopathology of an intracranial aneurysm treated using Guglielmi detachable coils: case report and review of the literature. Neurosurgery, 1998, 43(5) :1203-1238．
53． Graves VB, Strother CM, Duff TA, et al. Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding. Neurosurgery, 1995, 37(4) :640-647．
54． Byrne JV, Adams CB, Kerr RS, et al. Endosaccular treatment of inoperable intracranial aneurysms with platinum coils. Br J Neurosurg, 1995, 9(5) :585-592．
55． Yonas H, Kaufmann A. Combined extracranial-intracranial bypass and intraoperative balloon occlusion for the treatment of intracavernous and proximal carotid artery aneurysms. Neurosurgery, 1995, 36(6) :1234-1236．
56． VieVi, Duckwiler G, Mawad M. Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg, 1997, 86(3) :475-482．
57． Bernardini GL, Mayer SA, Kossoff SB. Anticoagulation and induced
hypertension after endovascular treatment for ruptured intracranial aneurysms. Crit Care Med, 2001, 29(3) : 641-644．
58． Collice M, DAliberti G, Arena O. Multidisciplinary (surgical and endovascular) approach to intracranial aneurysms. J Neurosurg Sci, 1998, 42(1 Suppl 1) : 131-140．
59． Suzuki J, Shigeaki, Sakurai Y. Intracranial aneurysms in the neurosurgical clinics in Japan. J Neurosurg, 1971, 35:34-39．
60． 王忠诚。神经外科学。湖北：湖北科学技术出版社，179～181。
61． Kallmes DF, Kallmes MH, Cloft HJ. Guglielmi detachable coil embolization for unruptured aneurysms in nonsurgical candidates: a cost-effectiveness exploration. AJNR Am J Neuroradiol, 1998, 19(1) :167-176．
62． Klezsch C, Nahser HC, Henkes H. Detection of microemboli distal to cerebral aneurysms before and after therapeutic embolization. AJNR Am J Neuroradiol, 1998, 19(7) :1315-1318．
63． Brilstra EH, Rinkel GJ, van der Graaf Y. Treatment of intracranial aneurysms by embolization with coils: a systematic review. Stroke, 1999, 30(2) :470-476．
64． Chiappetta F, Brunori A, Bruni P. Management of intracranial aneurysms: "state of the art". J Neurosurg Sci, 1998,42(1 Suppl 1) :5-13．
65． Yalamanchili K, Rosenwasser RH, Thomas JE. Frequency of cerebral vasospasm in patients treated with endovascular occlusion of intracranial aneurysms. AJNR Am J Neuroradiol, 1998, 19(3) :553-558．
66． Pelz DM, Lownie SP, Fox AJ. Thromboembolic events associated with the treatment of cerebral aneurysms with Guglielmi detachable coils. AJNR Am J Neuroradiol, 1998,19(8) :1541-1547．
67． Debrun GM, Aletich VA, Kehrli P. Evaluation of cerebral vasospasm after early surgical and endovascular treatment of ruptured intracranial aneurysms. Neurosurgery, 1998,43(3) :646-647．
68． Mericle RA, Wakhloo AK, Lopes DK. Delayed aneurysm regrowth and recanalization after Guglielmi detachable coil treatment. Case report.J Neurosurg, 1998, 89(1) : 142-145．
69． Polin RS, Shaffrey ME, Jensen ME. Medical management in the endovascular treatment of carotid-cavernous aneurysms. J Neurosurg, 1996, 84(5) :755-761．
70． Redekop GJ, Durity FA, Woodhurst WB. Management-related morbidity in unselected aneurysms of the upper basilar artery. J Neurosurg, 1997, 87(6) :836-842．
71． Zoarski GH,Bear HM, Clouston JC. Endovascular extraction of malpositioned fibered platinum microcoils from the aneurysm sac during endovascular therapy. AJNR Am J Neuroradiol, 1997,18(4) :691-695．
72． Civit T, Auque J, Marchal JC. Aneurysm clipping after endovascular treatment with coils: a report of eight patients. Neurosurgery, 1996, 38(5) :955-960．
73． Cronqvist M, Pierot L, Boulin A. Local intra-arterial fibrinolysis of thromboemboli occurring during endovascular treatment of intracerebral aneurysm: a comparison of anatomic results and clinical outcome. AJNR Am J Neuroradiol, 1998,19(1) :157-165．
74． Gugliehni G. A pitfall in the surgery of a recurrent aneurysm after coil embolization and its histological observation: technical case report. Neurosurgery, 1997,40(6) :1337-1341．
75． Levy DI. Embolization of wide-necked anterior communicating artery
aneurysm: technical note. Neurosurgery, 1997, 41 (4):979～982.
76. Proust F, Toussaint P, Harmequin D. Outcome in 43 patients with distal anterior cerebral artery aneurysms. Stroke, 1997, 28(12):2405～2409.
77. Bellone P, Domenicucci S, Chiarella F. Chronic aneurysmatic dilatation: a possible source of lethal embolization in patients with acute myocardial infarction undergoing thrombolysis. Int J Cardiol, 1996, 56(2):201～204.
78. Schnee CL, Flamm ES. Unusual aneurysms. Neuroimaging Clin N Am, 1997, 7(4):803～818.
79. Lefkowitz MA, Teitelbaum GP, Giannotta SL. Endovascular treatment of a dissecting posteroinferior cerebellar artery aneurysm: case report. Neurosurgery, 1996, 39(5): 1036～1038.
80．章梓雄，董曾南。粘性流体力学。北京：北京大学出版社，1982，459～470。
81．姜启源。数学模型(第二版)。北京：高等教育出版社，2002，94～97。
82．陈精一，蔡国忠。电脑辅助工程分析ANSYS使用指南。北京：中国铁道出版社，2001，25～209。
83．龚曙光。ANSYS基础应用及范例解析。北京：机械工业出版社，2003，29～421。
84．李皓月，周田朋，刘相新。ANSYS工程计算应用教程。北京：中国铁道出版社，2003，9～264。
85. Satoh K, Matsubara S, Hondoh H, et al. Intmcranial aneurysm embolization using interlocking detachable coils. Interventional neuroradiology, 1997, 3(Suppl 2): 125～128.
2．凌锋，李铁林，刘树山。介入神经放射学。北京：人民卫生出版社，1999，139～144。
3. Inci S, Spetzler RF. Intracranial aneurysms and arterial hypertersions: a review and hypothesis. Surg Neurol, 2000, 53(6):530～542.
4．曾司鲁，高摄渊，李旭光。脑血管解剖学。北京：科学出版社，1983，135～140。
5. Yasargil MG. Mieroneurosurgery[M]. Vol Ⅰ stutzgat, New York: Georg Thieme Verlag, 1984, 274～296.
6. Toumade A, Courtheoux P, Sengel C, et al. Saccular intracranial aneurysms: endovascular treatment with mechanical detachable spiral coils. Radiology, 1997, 202:481～486.
7. Leber KA, Klein GE, Trummer M, et al. Intracranial aneurysms: a review of endovascular and surgical treatment in 248 patients. Minim Invasive Neurosurg, 1998, 41:81～85.
8. Kallmes DF, Kallmes MH, Cloft HJ, et al. Guglielmi detachable coil embolization for unruptured aneurysms in nonsurgical candidates: a cost-effectiveness exploration. AJNR Am J Neuroradiol, 1998, 19:167～176.
9. Regli L, Uske A, Tribolet N. Endovascular coil placement compared with
surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: a consecutive series. J Neurosurg, 1999, 90:1025-1030．
10． Murayama Y, Viela F, Duckwiler GR, et al. Embolization of incidental cerebral aneurysms by using the Guglielmi detachable coil system. J Neurosurg, 1999, 90:207-214．
11． Solander S, Ulhoa A, Viela F, et al. Endovascular treatment of multiple intracranial aneurysms by using Guglielmi detachable coils. J Neurosurg, 1999, 90:857-864．
12． Cognard C, Pierot L, Boulin A, et al. Intracranial aneurysms: endovascular treatment with mechanical detachable spirals in 60 aneurysms. Radiology, 1997, 202:783-792．
13． Connolly ES, Solomon RA. Management of symptomatic and asymptomatic unruptured aneurysms. Neurosurg Clin N Am, 1998, 9:509-524．
14． Regli L, Uske A, Tribolet N. Endovascular coil placement compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: a consecutive series. J Neurosurg, 1999, 90: 1025-1030．
15． Bederson JB, Awad CIA, Wiebers DO, et al. Recommendations for the management of patients with unruptured intracranial aneurysms. Stroke, 2000,31:2742-2750．
16． Fujiwara NH, Cloft HJ, Marx W, et al. Senai angiography in an elastase-induced aneurysm modei in rabbits: evidence for progressive aneurysm enlargement after creation. AJNR Am J Neuroradiol, 2001, 22(4) : 698-703．
17． 苏正，李铁林，黄庆。弹性蛋白酶快速诱发动脉瘤动物模型实验研究。 中国神经精神疾病杂志，2002，28(3) ：182-184。
18． Aenis M, Stancampiano AP, Wakhloo AK. Modeling of flow in straight stented and nonstented side wall aneurysm model. J Of Biomech. Eng, 1997,119:206-211．
19． Burleson AC. Identification of quantifiable hemodynamic factors in the assessment of cerebral aneurysm behavior.(On behalf of the subcommittee on Biorheology of the Scientific and Standardization Committee of the ISTH). Thromb Haemost, 1996, 76:118-123．
20． Burleson AC, Strother CM, Turitto VT. Computer modeling of intracranial saccular and lateral aneurysms for the study of their hemodynamics, Neurosurgery, 1995; 37: 774-784．
21． Perktold K, Kenner T, Hilbert D, et al. Numerical blood flow analysis: arterial bifurcation with a saccular aneurysum, Basic Res. in Cardiology, 1998; 83: 24-31．
22． Perktold K, Peter R, Resch M. Pulsatile nonnewtonian blood flow simulation through a bifurcation with an aneurysm. Biorheology, 1991, 26: 1011-1030．
23． Low M, Perktold K, Raunig R. Hemodynamics in rigid and distensible saccular aneurysms: A numerical study of pulsatile flow characteristics. Biorheology, 1993, 30: 287-298．
24． Hayashi K, Handa H, Nagasawa S. Stiffness and elastic behavior of human intracranial and extracranial arteries. J Biomechanics, 1980, 13: 175-184．
25． Foutrakis GN, Yonas H, Sclabassi RJ. Saccular aneurysm formation in curved and bifuracation arteries. AJNR, 1999, 20:1309-1317．
26． Liepsch DW, Steiger HJ, Poll A. Hemodynamic stress in lateral saccular aneurysms. Biorheology, 1987, 24: 689-710．
27． Gonzalez CF, Cho YL, Ortega HV. Intracranial aneurysms: Flow analysis of their origin and progression. AJNR, 1992, 13 :181-188．
28． Ujiie H, Liepsch DW, Goetz M, et al. Hemodynamic study of the anterior communicating artery. Stroke, 1996, 27:2086-2094．
29． Steiger HJ, Poll A, Liepsch DW. Basic flow structure in saccular aneurysms: a flow visualization study. Heart Vessels, 1987, 3:55-65．
30． Yamaguchi R. Distribution of mass transfer rate and wall shear stress behind simple rectangular stenosis in pulsating flow. J Biomech Eng, 1989,111:47-54．
31． Liepsch DW. Flow in tubes and arteries: a comparison. Biorheology, 1986, 23:395-433．
32． Griffith TM, Edwards DH, Davies RL. EDRF coordinates the behaviour ofvascular resistance vessels. Nature, 1987, 329:442-445．
33． Moncada S, Palmer RMJ, Higgs EA. Nitric oxide: physiology, pathophysiology and pharmacology. Pharmacol Rev, 1991, 43:109-142．
34． Levesque MJ, Liepsch DW, Moravec S. Correlation of endothelial cell shape and wall shear stress in a stenosed dog aorta. Arteriosclerosis, 1986, 6:220-229．
35． Rossitti S, Loefgren J. Vascular dimensions of the cerebral arteries follow the principle of minimum work. Stroke, 1993, 24:371-377．
36． 黄勤，付万新，柳浩然。前交通动脉复合体的解剖学研究。中华神经 医学杂志，2002，1(1) ：14～17。
37． Kirgis HD, Frsher WL, Liewellyn RC, et al. Aneurysm of the anterior communicating artery and gross anatomy of the circle of willis. J Neurosurg, 1966, 25(1) : 73．
38． 凌锋，李铁林，鲍玉海。介入神经放射影像学。北京：人民卫生出
版社，1999，261～280。
39． Eskridge JM, Song JK. Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils: results of the Food and Drug Administration multicenter clinical trial. J Neurosurg, 1998, 89:81-86．
40． Amagasaki K, Yagishita T, Yagi S, et al. Serial angiography and endovascular treatment of dissecting aneurysms of the anterior cerebral and vertebral arteries. Case report. J Neurosurg, 1999, 91(4) :682-686．
41． Vespa PM, Gobin YP. Endovascular treatment and neurointensive care of ruptured aneurysms. Crit Care Clin, 1999, 15(4) :667-684．
42． Murayama Y, Suzuki Y, Viuela F, et al. Development of a biologically active Guglielmi detachable coil for the treatment of cerebral aneurysms. Part Ⅰ: in vitro study. AJNR Am J Neuroradiol, 1999, 20(10) :1986-1991．
43． 刘承基。脑血管外科学。南京：江苏科学技术出版社，2000，67～75。
44． Cekirge HS, Islak C, Firat MM, et al. Endovascular coil embolization of residual or recurrent aneurysms after surgical clipping. Acta Radiol, 2000, 41(2) :111-115
45． Pruvo JP, Leclerc X, Ares GS, et al. Endovascular treatment of ruptured intracranial aneurysms. J Neurol, 1999, 246(4) :244-249．
46． Moret J, Ross IB, Weill A, et al. The retrograde approach: a consideration for the endovascular treatment of aneurysms. AJNR Am J Neuroradiol, 2000, 21(2) :262-268．
47． Malek AM, Halbach W, Phatouros CC, et al. Balloon-assist technique for endovascular coil embolization of geometrically difficult intracranial aneurysms. Neurosurgery, 2000, 46(6) : 1397-1407．
48． Lempert TE, Malek AM, Halbach VV, et al. Endovascular treatment of ruptured posterior circulation cerebral aneurysms. Clinical and
angiographic outcomes. Stroke, 2000, 31(1) :100-110．
49． Jizong Z, Shuo W, Jingsheng L. Combination of intraoperative embolization with surgical resection for treatment of giant cerebral arteriovenous malformations. J Clin Neurosci, 2000, 7 (1) : 54-59．
50． 张友平，吴中学，孙永权。经Mata’s压颈试验颈内动脉瘤自行闭塞 三例。中华神经外科杂志，1995，11(增刊)：60。
51． King WA, Martin NA. Critical care of patients with subarachnoid hemorrhage. Neurosurg Clin N Am, 1994,5(4) :767-787．
52． Stiver SI, Porter PJ, Willinsky RA. Acute human histopathology of an intracranial aneurysm treated using Guglielmi detachable coils: case report and review of the literature. Neurosurgery, 1998, 43(5) :1203-1238．
53． Graves VB, Strother CM, Duff TA, et al. Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding. Neurosurgery, 1995, 37(4) :640-647．
54． Byrne JV, Adams CB, Kerr RS, et al. Endosaccular treatment of inoperable intracranial aneurysms with platinum coils. Br J Neurosurg, 1995, 9(5) :585-592．
55． Yonas H, Kaufmann A. Combined extracranial-intracranial bypass and intraoperative balloon occlusion for the treatment of intracavernous and proximal carotid artery aneurysms. Neurosurgery, 1995, 36(6) :1234-1236．
56． VieVi, Duckwiler G, Mawad M. Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg, 1997, 86(3) :475-482．
57． Bernardini GL, Mayer SA, Kossoff SB. Anticoagulation and induced
hypertension after endovascular treatment for ruptured intracranial aneurysms. Crit Care Med, 2001, 29(3) : 641-644．
58． Collice M, DAliberti G, Arena O. Multidisciplinary (surgical and endovascular) approach to intracranial aneurysms. J Neurosurg Sci, 1998, 42(1 Suppl 1) : 131-140．
59． Suzuki J, Shigeaki, Sakurai Y. Intracranial aneurysms in the neurosurgical clinics in Japan. J Neurosurg, 1971, 35:34-39．
60． 王忠诚。神经外科学。湖北：湖北科学技术出版社，179～181。
61． Kallmes DF, Kallmes MH, Cloft HJ. Guglielmi detachable coil embolization for unruptured aneurysms in nonsurgical candidates: a cost-effectiveness exploration. AJNR Am J Neuroradiol, 1998, 19(1) :167-176．
62． Klezsch C, Nahser HC, Henkes H. Detection of microemboli distal to cerebral aneurysms before and after therapeutic embolization. AJNR Am J Neuroradiol, 1998, 19(7) :1315-1318．
63． Brilstra EH, Rinkel GJ, van der Graaf Y. Treatment of intracranial aneurysms by embolization with coils: a systematic review. Stroke, 1999, 30(2) :470-476．
64． Chiappetta F, Brunori A, Bruni P. Management of intracranial aneurysms: "state of the art". J Neurosurg Sci, 1998,42(1 Suppl 1) :5-13．
65． Yalamanchili K, Rosenwasser RH, Thomas JE. Frequency of cerebral vasospasm in patients treated with endovascular occlusion of intracranial aneurysms. AJNR Am J Neuroradiol, 1998, 19(3) :553-558．
66． Pelz DM, Lownie SP, Fox AJ. Thromboembolic events associated with the treatment of cerebral aneurysms with Guglielmi detachable coils. AJNR Am J Neuroradiol, 1998,19(8) :1541-1547．
67． Debrun GM, Aletich VA, Kehrli P. Evaluation of cerebral vasospasm after early surgical and endovascular treatment of ruptured intracranial aneurysms. Neurosurgery, 1998,43(3) :646-647．
68． Mericle RA, Wakhloo AK, Lopes DK. Delayed aneurysm regrowth and recanalization after Guglielmi detachable coil treatment. Case report.J Neurosurg, 1998, 89(1) : 142-145．
69． Polin RS, Shaffrey ME, Jensen ME. Medical management in the endovascular treatment of carotid-cavernous aneurysms. J Neurosurg, 1996, 84(5) :755-761．
70． Redekop GJ, Durity FA, Woodhurst WB. Management-related morbidity in unselected aneurysms of the upper basilar artery. J Neurosurg, 1997, 87(6) :836-842．
71． Zoarski GH,Bear HM, Clouston JC. Endovascular extraction of malpositioned fibered platinum microcoils from the aneurysm sac during endovascular therapy. AJNR Am J Neuroradiol, 1997,18(4) :691-695．
72． Civit T, Auque J, Marchal JC. Aneurysm clipping after endovascular treatment with coils: a report of eight patients. Neurosurgery, 1996, 38(5) :955-960．
73． Cronqvist M, Pierot L, Boulin A. Local intra-arterial fibrinolysis of thromboemboli occurring during endovascular treatment of intracerebral aneurysm: a comparison of anatomic results and clinical outcome. AJNR Am J Neuroradiol, 1998,19(1) :157-165．
74． Gugliehni G. A pitfall in the surgery of a recurrent aneurysm after coil embolization and its histological observation: technical case report. Neurosurgery, 1997,40(6) :1337-1341．
75． Levy DI. Embolization of wide-necked anterior communicating artery
aneurysm: technical note. Neurosurgery, 1997, 41 (4):979～982.
76. Proust F, Toussaint P, Harmequin D. Outcome in 43 patients with distal anterior cerebral artery aneurysms. Stroke, 1997, 28(12):2405～2409.
77. Bellone P, Domenicucci S, Chiarella F. Chronic aneurysmatic dilatation: a possible source of lethal embolization in patients with acute myocardial infarction undergoing thrombolysis. Int J Cardiol, 1996, 56(2):201～204.
78. Schnee CL, Flamm ES. Unusual aneurysms. Neuroimaging Clin N Am, 1997, 7(4):803～818.
79. Lefkowitz MA, Teitelbaum GP, Giannotta SL. Endovascular treatment of a dissecting posteroinferior cerebellar artery aneurysm: case report. Neurosurgery, 1996, 39(5): 1036～1038.
80．章梓雄，董曾南。粘性流体力学。北京：北京大学出版社，1982，459～470。
81．姜启源。数学模型(第二版)。北京：高等教育出版社，2002，94～97。
82．陈精一，蔡国忠。电脑辅助工程分析ANSYS使用指南。北京：中国铁道出版社，2001，25～209。
83．龚曙光。ANSYS基础应用及范例解析。北京：机械工业出版社，2003，29～421。
84．李皓月，周田朋，刘相新。ANSYS工程计算应用教程。北京：中国铁道出版社，2003，9～264。
85. Satoh K, Matsubara S, Hondoh H, et al. Intmcranial aneurysm embolization using interlocking detachable coils. Interventional neuroradiology, 1997, 3(Suppl 2): 125～128.