颅内动脉瘤外科治疗的疗效分析

The analysis of intracranial aneurysms undergoing surgical treatment

目的 探讨颅内动脉瘤的手术治疗原则和治疗方法 .方法 回顾性总结分析2009年1月至12月139例颅内动脉瘤的治疗效果.其中80例行开颅手术治疗,59例行介入治疗.开颅手术采用动脉瘤夹闭、孤立及包裹等方法 ;介入治疗采用动脉瘤单纯栓塞、支架辅助栓塞等方法 .开颅手术中常规使用脑电图及体感诱发电位进行监测.术中应用多普勒超声和荧光血管造影监测血流情况.结果 80例开颅手术中动脉瘤夹闭73例,颈内动脉阻断动脉瘤孤立6例,动脉瘤包裹1例.59例介入治疗中单纯栓塞33例,支架辅助栓塞26例.80例开颅手术治疗患者中,出院时格拉斯哥预后评分（GOS）5～4分者71例（88.8%）,3分者6例（7.5%）,2分者1例（1.2%）,1分者2例（2.5%）.59例介入治疗患者GOS评分5～4分者54例（91.5%）,3分者5例（8.5%）.结论 开颅手术和介入治疗是颅内动脉瘤的主要治疗方法 ,应当根据患者的实际情况,采取个性化的治疗策略,使患者得到安全、有效、持久的治疗.

Objective To study the surgical principles and treatment options of intracranial aneurysms. Methods One hundred and thirty nine patients with intracranial aneurysms were retrospectively studied,including 80 open-surgery cases and 59 endovascular-treated cases from January to December in 2009. Open surgical methods included clipping, trapping or wrapping and interventional methods included simple coiling or stent-assisted coiling. Intra-operative electroencephalogram and somatosensory evoked potentials monitoring were regularly used. Microvascular doppler ultrasonography and indocyanine green videoangiography were used to assess blood flow in parent and branch vessels. Results Seventy-three aneurysms were directly clipped, 6 were trapped and 1 was wrapped. Thirty-three aneurysms were coiled and 26 were coiled assisted with stents. At discharge, 71 of the 80 （88.8%）surgical treated patients had Glasgow Outcome Scale score of 4 or 5 points, 3 points in 6 patients （7.5%）, 2 points in 1 patient （1.2%）, and 1 point in 2 patients（2. 5% ）. Fifty-four out of 59 cases underwent endovascular treatment scored 4 or5 points（91.5%）and 3 points in 5 patients （8.5%）. Conclusions Surgical clipping and endovascular coiling are two major treatment choices for intracranial aneurysms. The treatment option should be individualized based on the patients＇ specific conditions, which could have a safe, effective and durable outcome.