显微神经外科手术和血管内介入治疗Ⅳ、Ⅴ级颅内动脉瘤对比研究

Contrast study of microsurgical and endovascular interventional therapies for treating intracranial aneurysms of Hunt-Hess Ⅳ and Ⅴ

目的比较显微神经外科手术和血管内介入治疗Hunt-Hess分级为Ⅳ、Ⅴ级的破裂动脉瘤的疗效及优缺点。方法回顾性分析26例Ⅳ、Ⅴ级破裂动脉瘤的治疗,11例行开颅显微手术,15例行血管内介入治疗。结果手术组11例中良好、轻残者5例,占45.5%;重残、植物生存者4例,占36.4%;死亡者2例,占18.2%,与手术有一定关系;介入组15例中良好、轻残者8例,占53.3%;重残、植物生存者5例,占33.3%;死亡者2例,占13.3%,并非介入治疗并发症所致。结论Ⅳ、Ⅴ级破裂动脉瘤病人状态差,入院后应根据病情针对脑室出血、颅内血肿、脑疝等情况进行处理,并尽早行手术或介入治疗。介入治疗创伤小、适应证广、并发症少,应作为Ⅳ、Ⅴ级颅内破裂动脉瘤的首选治疗方法。

Objective To analyze therapeutic efficacy, merits and demerits of microsurgical or endovascular interventinal therapies in the treatment of intracranial ruptured aneurysms of Hunt-Hess ⅣandⅤ. Methods 11 aneurysms were operated on under microscope and 15 aneurysms by endovascular intervention; all the cases were studied retrospectively. Results In the microsurgical group, 5 cases (45.5%) got in a good recovery or mild disability, 4 (36.4%) in severe disability or persistent vegetative state, and 2 (18.2%) in death, being related to operation; in the interventional group, 8 cases (53.5%) got in a good recovery or mild disability, 5 (33.3%) in severe disability or persistent vegetative state, and 2 (13.3%) in death, not resulting from interventional therapy. Conclusion Patients of ⅣorⅤ intracranial ruptured ameurysm, in an emergent state, should be treated aiming at specific complications such as ventricular hemorrhage, intracranial hematoma, cerebral hernia, and so on. Microsurgical or endovascular interventional therapies ought to be performed immediately, but endovascular intervention is preferable because of the advantages of smaller invasion, more indications and fewer complications.