早期显微外科手术夹闭动脉瘤22例治疗体会

Treatment experience in 22 cases of intracranial aneurysm with early microsurgery

目的探讨动脉瘤显微外科手术时机、术中处理及术后治疗方法。方法分析22例在72h内行显微外科手术,术前术中采用了过度换气、脱水药物、侧脑室穿刺释放脑脊液等多种方法降低颅内压。术后采用"3H"疗法并应用尼莫地平。结果成功夹闭动脉瘤21例,动脉瘤包裹1例。Hunt-Hess分级Ⅰ-Ⅲ级20例中,治愈17例,轻残2例,重残1例;Ⅳ级2例中,重残1例,死亡1例。结论早期显微手术夹闭动脉瘤,可早期预防动脉瘤破裂后蛛网膜下腔出血引起的脑血管痉挛,有效地防止脑缺血或脑梗死和动脉瘤再出血的发生。

Objective To investigate the timing of microsurgery,intraoperative treatment and postoperative therapy for intracranial aneurysm.Methods The clinical data of 22 cases underwent microsurgery within 72 h,adequately to obtained the necessary operation room and intracranial pressure reducing were achieved by judicious use of many preoperative and intraoperative measures such as hyperventilation,diuresis and intraoperative ventriculostomy,etc.Nimodipine and triple-H therapy were utilized to prevent and treat cerebral vasospasm following aneurysmal subarachnoid hemorrhage after operation.Results 21 intracranial aneurysms were clipped,1intracranial aneurysm was wrapped.In 20 patients of Hunt and Hess classification gradeⅠ-Ⅲ,good outcome was achieved in 17 cases,moderate disability in 2 cases,severe disability in 1 case.In 2 patients of Hunt and Hess classification grade Ⅳ,severe disability in 1 case and 1 patient died.Conclusion Early operation for intracranial aneurysms could permit a more aggressive treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage,prevent or decrease the severity of cerebral ischemia or infarction,and eliminate the risk of rebleeding.