i
LỜI CẢM ƠN

              
 - Khoa 


c, Kt Tn kinh,
- 


- 


nguyên Phó ch           

 

Tôi xin           
 



 
   
T
               

 t


 x
ĐẶT VẤN ĐỀ i
CHƢƠNG 1: TỔNG QUAN 3
1.1. Lịch sử nghiên cứu chẩn đoán và điều trị túi phình động mạch não 3
 3
 5
1.2. Giải phẫu mạch cấp máu cho não 7
 7
 8
1.3. Đặc điểm bệnh lý túi phình động mạch não 9
 9
 9
 10
 11
 15
1.4. Chẩn đoán túi phình động mạch não 15

iv
 15
 17
1.5. Các phƣơng pháp điều trị túi phình động mạch não vỡ 27
 27
 29
 31
CHƢƠNG 2: ĐỐI TƢỢNG VÀ PHƢƠNG PHÁP NGHIÊN CỨU 35
2.1. Đối tƣợng nghiên cứu 35
2.2. Phƣơng pháp nghiên cứu 36
 36
 36
 37

4.3.6. Bi 115
 116
 119
KẾT LUẬN 123
DANH MỤC CÁC CÔNG TRÌNH CÔNG BỐ
KẾT QUẢ NGHIÊN CỨU CỦA ĐỀ TÀI LUẬN ÁN
TÀI LIỆU THAM KHẢO
PHỤ LỤC

vi
NHNG CH VIT TT TRONG LUN N

Ting Vit
BN
CHT
CLVT
CMDMN
CS
DNT
M
MN
(Stent)
PTTK
THA
VXKL (Coils)

Ting Anh
95%CI
DSA : Digital Subtraction Angiography


 59
3.6: -
 60
3.7:  61
3.8:  62
3.9:  63
3.10:  63
3.11:  64
3.12: 
 65
3.13:  66
3.14:  
 67

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3.15:  68
3.16:  69
3.17:  69
3.18:  70
3.19:  71
3.20:  71
3.21:  72
3.22:  73
3.23:  74
3.24:  75
3.25:  75
3.26:  76

3.10: -Hess 73
3.11:  74
3.12:  78
3.13:   80
3.14:  80
3.15:   81
3.16:  82 x
DANH MỤC CÁC HÌNH ẢNH

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1.1:  7
1.2:  10
1.3:  14
1.4:  15
1.5:  
 18
1.6:  19
1.7: 
 21
1.8: 
 21
1.9:  23
1.10:  24
1.11: 
 25

4.7: 
 100
4.8: 
 101
4.9:  106
4.10:  107
4.11:  
 108

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Trang
4.12: 
 108
4.13:  109
4.14:  110
4.15: 
 110
4.16: 
 110
4.17: (a), (b) 
não  
 111
4.18: 
 (b) 112
4.19: 
 113
ích  túi  là c
 phình
phình 
 phìnhphình qua 
 (coil).
, túi  
  
  kinh.

 (  
) và     ã thúc
túi phình  cho 

  
 ,  h , Xquang
  
i phình  t (ISAT 2009
[27]), còn  .
 "
túi   hai :
1. Mô tả đặc điểm lâm sàng, hình ảnh cắt lớp vi tính và chụp
mạch số hóa xóa nền túi phình động mạch não vỡ.
2. Đánh giá kết quả điều trị vi phẫu thuật túi phình động mạch
não vỡ. 3
CHƢƠNG 1
TỔNG QUAN


.
.

 

Alaa, Li, Scoville,        


 [23], [57], [81], [118], [130].
 

   
112].
            
            s
(Guglielmi Detachable Coils).

 






5
 
 

[94], [116].
1.1.2. Ở trong nƣớc

ph ng hp.
ng s báo cáo vi phu thung
hng clip Sugita; kt qu tt 93%, t vong 7.
h

[1].

   
7,512].

 


           
16].


 vong [19].
7
1.2. GIẢI PHẪU MẠCH CẤP MÁU CHO NÃO

 (vòng Willis) [9],
[105], [113].
1.2.1. Hệ động mạch cảnh trong




 
nên các phình  
 [10].
- 
              

1.2.2. Hệ động mạch đốt sống thân nền
+ 



  

 9
+ :
- 

-  



  vùng 
sau,  [70].
1.3. ĐẶC ĐIỂM BỆNH LÝ TÚI PHÌNH ĐỘNG MẠCH NÃO
1.3.1. Nguyên nhân bệnh sinh
Nguyên nhân còn 
+    :       ,  

[18], [83].
1.3.3. Phân bố vị trí túi phình động mạch não


-


126].
Hình 1.2: 
 (2002) [126].

             
- 90%-35%)
- 5-
Túi phình ĐM
thông trƣớc
Túi phình đỉnh
thân nền
Túi phình
ĐM sống nền
Túi phình
ĐM tiểu não
sau dƣới
Túi phình ĐM
tiểu não trên
Túi phình
ĐM não giữa




12


23], [29].
+  viêm: sau CMDMN 
    
interleukin, E-secretin, collagen type
là p [40], [78], [98].
CMN,
, là nguyên nhân chín 
M 

 




[38], [42], [53], [86].




              

 [120].

thá