急诊显微外科手术治疗出血性脑动脉瘤

Emergent microsurgical treatment for hemorrhagic intracranial aneurysms

目的探讨86例不同部位脑动脉瘤破裂出血后的临床表现及急诊显微手术治疗策略。方法回顾分析1990年1月至2002年12月,86例共87个脑动脉瘤破裂引起蛛网膜下腔出血(SAH)或脑内出血病例。经CT、螺旋CT三维脑血管成像、MRA脑血管成像或数字减影血管造影(DSA)检查确诊脑动脉瘤,采用翼点或扩大翼点入路显微镜下急诊清除颅内血肿和蛛网膜下腔积血,同时手术夹闭破裂出血的动脉瘤87个。结果86例破裂出血的脑动脉瘤均获夹闭。56例恢复良好,16例生活可自理,5例植物生存,9例死亡。结论急诊早期显微手术治疗破裂出血的脑动脉瘤,可防止动脉瘤的再次破裂出血;清除颅内血肿和蛛网膜下腔积血,可以有效降低颅内压,减轻脑血管痉挛的发生和发生痉挛的严重程度;去骨瓣减压是最快捷、最有效解除颅内高压的手段,有利于降低患者的致残率及死亡率。

Objective To analyze the clinical features and the effect of treatment with microsurgical techniques in 86 cases with ruptured intracranial aneurysms.Methods A retrospective analysis had been made in 87 aneurysms of 86 cases from January 1990 to December 2002. All cases had been diagnosed by computed tomography (CT), CT angiography , magnetic resonance angiography (MRA) and digital subtraction angiography (DSA). These ruptured aneurysms were all treated with microsurgery in emergency. The microsurgical techniques for preventing the aneurysms from rupturing again during the operation and the curative effects were discussed.Results The ruptured aneurysms were clipped successfully in 86 cases. Fifty-six cases obtained good outcomes, 16 cases were able to take care of themselves, 5 cases were vegetative state and 9 cases were dead.Conclusion The ruptured aneurysm should be treated with microneurosurgery in emergency in order to prevent rupturing again as soon as the diagnosis is made. The clearance of intracerebral and subarachnoid hematomas can reduce the incidence of vasospasm and the intracranial pressure. The craniotomy is the most effective way to relieve the elevated intracranial pressure, and is helpful to reduce the mortality and morbidity.