老年人颅内多发动脉瘤的外科治疗

Surgical intervention for multiple intracranial aneurysm in elder patients

目的探讨老年人颅内多发动脉瘤(MIA)的治疗原则及其预后。方法20例老年颅内多发动脉瘤患者。一期开颅手术夹闭动脉瘤13例;分期介入栓塞多发动脉瘤3例;二期开颅治疗动脉瘤3例;一期手术夹闭后交通动脉瘤,二期介入栓塞眼动脉瘤1例。结果20例手术全部成功,存活率100%。因手术新出现神经系统体征2例,1例偏瘫,1例昏迷;半年以上的随访,1例恢复,1例植物生存。手术前有神经系统体征表现16例,其中6例动眼神经瘫痪,3例脑积水,5例偏瘫,2例失语。术后2例偏瘫未恢复,3例动眼神经瘫痪部分恢复,2例失语症状改善,其余恢复良好;3例脑积水中,2例手术后脑室缩小,1例无明显变化。结论根据患者条件和具体情况,尽早实施外科干预治疗老年人颅内多发动脉瘤,预后良好。

Objective To investigate the therapy and prognosis of multiple intracranial aneurysm（MIA） in elder patients. Methods Data of twenty patients were collected and analyzed. Thirteen cases of patients received craniotomy and ar.eurysms were occluded; three cases of patients received endovascular interventional therapy by staging; three cases of patients received craniotomy and one patient received craniotomy and microsurgery and then endovascular interventional therapy. Results All patients survived with the survival rate of 100%. Two cases presented new neurosigns, including one hemiparalysis and one coma,however, half year of follow-up found one recovered and one was in vegetation state. The neurosigns before surgery were present in 16 cases, including six oculomotor nerve palsy,three hydrocephalus ,five hemiparalysis and two aphasia. After operation two patients with hemiparalysis did not recover, three patients with oculomotor nerve palsy recovered partly, two patients with aphasia improved and other cases well recovered. Among 3 cases of hydrocephalus ,two patients ＇ cerebral ventricle was contracted and one had no change. Conclusion According to the conditions and clinical state, early surgical interventional therapy is applied in elder patients with multiple intracranial aneurysm , which can improve the prognosis.