颅内动脉瘤438例显微手术分析

Microsurgery for intracranial aneurysm：analysis of 438 cases

目的总结438例患者的508个动脉瘤的显微手术治疗经验。方法回顾性总结分析438例患者的临床资料，包括围手术期处理、手术时机、术中处理要点、动脉瘤分级。结果共476个动脉瘤显微手术治疗成功，其中直接瘤颈夹闭450个，包裹14个，孤立8个，切除动脉瘤4个。术中动脉瘤破裂32个（6．72％）。术前Hunt-Hess分级与手术死亡率正相关。延期（≥7d）手术患者病死率（4．28％），明显低于早期手术病死率。结论正确的显微外科手术入路治疗颅内动脉瘤是一个十分有效的治疗手段。术前Hunt-Hess分级越高，病死率越高。

Objective To summarize the experience of surgical therapy in a series of 438 patients with intracranial aneurysms. Methods A retrospective analysis was made on the clinical data of 438 patients, in terms of the perioperative management, timing of surgery, surgical skills, and The HUNT-HESS grade. Results 438 patients with 476 aneurysms underwent microsurgery, in which 450 aneurysms were clipped,14 were wrapped, 8 were isolated,4 were cut. 32 aneurysms were ruptured （6.72%） during the operation. The relation between Hunt-Hess scale and mortality is significant postpone operation （ ≥7 d） has got a better curative effect than the early. Conclusions Microsurgical treatment is a confirmed effective method with intracranial aneurysms. The higher of HUNT-HESS grade will result to the worse clinical outcome.