大脑中动脉动脉瘤的诊断与治疗

Diagnosis and Treatment of Middle Cerebral Aneurysm

1980年5月～1994年4月经治颅内动脉瘤134例,其中大脑中动脉动脉瘤(MCAA)21例占15.7％,男10例、女11例,平均年龄48.1岁。21例以蛛网膜下腔出血(SAH)发病,18例有暂短意识障碍,其中3例不久陷入深昏迷,4例意识逐渐恶化,此7例均有继发颅内血肿。CT显示SAH外侧裂池积血呈孤形是其重要特点。出血量较大可扩散到终板池、交叉池、脚间池及对侧侧裂池等。7例脑内血肿2例位于颞叶,5例位于颞叶深部,达基底节区,其中2例破入脑室。脑血管造影是诊断MCAA的主要手段,本组21例发现MCAA23个,其中多发动脉瘤7例占33.33％。18例取手术治疗,采用Yasargil入路,手术死亡1例。另外,本组造影死亡2例,共3例。

From May 1980 to April 1994,134 cases of cerebral aneurysm received clipping operations,21 cases of them were middle cerebral artery aneurysms (MCAA)(15. 7%). Ten cases were male and 11 cases female. The mean age was 48- l years. Twenty patients suffered from subarachnoid hemorrhage due to ruptured intracranial aneurysms. Eighteen patients had temporary loss of conscious-ness,seven of them developed coma later,all the seven patients had intracranial hematomas. CT scan revealed subarachnoid hemorrhage. It was typical that hemorrhage of ruptured MCAA was lo-cated in the Sylvian cisterns. Angiography was a valuable measure for the diagnosis of MCAA,but sometimes it could not reveal small aneurysms. Seven cases had multiple aneurysms (33- 3%). Eighteen cases were operated by Yasargil approach,aneurysms were clipped. One patient died on opera-tion.and 2 patients died on angiography.