表现为侧裂区血肿的颅内动脉瘤的诊断和治疗

The diagnosis and treatment of intrasylvian hematoma due to ruptured intracranial aneurysms

目的探讨颅内动脉瘤破裂导致侧裂区血肿的诊断和处理原则。方法本组男7例,女5例,年龄18～63岁,平均49岁。12例侧裂区血肿均经脑血管造影（DSA）或CT脑血管造影（CTA）检查确诊,其中大脑中动脉瘤9例,后交通动脉瘤2例,后交通动脉瘤合并大脑中动脉瘤1例。本研究对其临床表现、影像学特点及处理原则分别进行了分析。结果12例患者中有10例经开颅动脉瘤夹闭及血肿清除术,1例行经股动脉穿刺血管内弹簧圈栓塞治疗,1例经DSA检查明确动脉瘤后术前准备时再出血,抢救无效死亡。术后1例患者出现脑梗死,经对症治疗好转,3例遗留神经功能障碍,其余病人恢复良好。结论表现为侧裂区的自发性脑内血肿,很有可能是动脉瘤破裂出血所致,需尽早行DSA或CTA检查明确诊断,治疗以手术为首选,术中夹闭动脉瘤并将血肿清除。

Objective To discuss the diagnosis and treatment principle of intrasylvian hematoma due to ruptured intracranial aneurysms. Methods In this retrospective study, twelve patients of intrasylvian hematomas following ruptured aneurysms were analyzed. There were 7 males and 5 females ranging in age from 18-63 years, the mean age was 49 years. All patients with intracerebral hematoma were diagnosed by CTA or DSA. Among these, 9 cases were middle cerebral artery aneurysms, 2 cases were posterior communicating artery aneurysms, 1 case was middle cerebral artery and posterior communicating artery aneurysm. Results 10 patients were microsurgically treated by pterional approach to evacuate intracerebral hematomas and to clip the ruptured aneurysms. One patient accepted endovascular embolization. One patient died before surgery due to re-rupture of aneurysm. Conclusions We suggest that early surgical management should be performed for intrasylvian hematomas following ruptured intracranial aneurysms. Pre-operative angiography or CTA are essential for the correct diagnosis of intracranial aneurysms.