开颅手术夹闭颅内多发动脉瘤的方法与疗效分析

Analysis of surgical treatment for patients with multiple intracranial aneurysms

目的探讨开颅手术夹闭颅内多发动脉瘤的效果.方法对45例颅内多发动脉瘤患者(94个动脉瘤),按照格拉斯哥昏迷量表(GCS)进行了评分,其中13～15分31例,8～12分10例,8分以下4例.根据术前DSA显示多发动脉瘤部位,结合CT等判断破裂动脉瘤位置,选择左侧或右侧翼点入路,在手术显微镜下,一期开颅手术治疗36例,夹闭68个动脉瘤,包裹6个动脉瘤.二期手术夹闭3例6个动脉瘤,6例患者仅处理破裂动脉瘤.结果共夹闭动脉瘤80个,包裹动脉瘤6个.45例手术患者无与手术相关的死亡病例.1例死于术后呼吸、心跳骤停,植物生存1例,偏瘫2例,术前动眼神经麻痹5例,其中2例恢复,3例无变化.术后GCS评分,13～15分38例,8～12分6例,8分以下1例.结论对于符合颅内多发动脉瘤手术适应证的患者应该尽可能采取一期夹闭,一侧翼点入路可以同时夹闭大部分多发动脉瘤,包括部分位于双侧的多发动脉瘤,手术治疗对于颅内多发动脉瘤的预后起重要作用.

Objective To study the clinical effects of surgical treatment for patients with multiple intracranial aneurysms. Methods 45 patients with multiple intraeranial aneurysms were treated with microsurgery. According to the Glasgow Coma Scale （GCS）, 31 were 13 to 15, 10 were 8 to 12 and 4 were less than 8. Digital subtraction angiography （DSA） was applied to confirm the loeation of the multiple aneurysms preoperatively. CT scan was applied for diagnosis of ruptured aneurysm. Left or right pterion approach was chosen according to the location of aneurvsms. Under microscope, 36 cases with 68 aneurysms were clipped and 6 were wrapped in one stage and 3 cases with 6 aneurysms were clipped in two-stage operation. In 6 cases, only the ruptured aneurysms were treated. Results 80 aneurysms were clipped and 6 were wrapped . There was no operative mortality. 1 patient died of heart failure, l was lived in vegetative state, 2 were hemiparalyzed and 2 out of 5 patients who had oculomotor nerve paralysis recovered after surgery. The GCS score of 38 patients were 13 to 15, 6 were 8 to 12 and l was less than 8 postoperatively. Conclusion Clipping of multiple intracranial aneurysms in one-stage operation is recommended. Pterion approach is capable for treating most of multiple aneurysms, even if some locate on the bilateral side. Surgery plays an important role in the management of patients with multiple aneurysms.