大脑中动脉瘤破裂伴脑内血肿的急诊手术治疗

Emergent operation for ruptured middle cerebral artery aneurysm associated with intracerebral hematoma

目的总结经翼点或额颞入路急诊手术治疗大脑中动脉瘤(MCAA)破裂伴脑内血肿的经验。方法回顾性分析21例显微手术治疗的MCAA病人的病历资料。结果动脉瘤成功夹闭19例,行瘤壁包裹加固术1例,切除动脉瘤2例。术后随访3～24个月,恢复良好16例,致残5例。结论采用经翼点或额颞入路,对伴有血肿的患者急诊手术可清除血肿解除占位效应;对动脉瘤进行夹闭可防止再次破裂出血。

Object To summarize emergent operation experience of trans-pterion or trans- frontotemporal approach for ruptured middle cerebral artery aneurysm （MCAA） with intracerebral hematoma. Methods The clinical data of 21 patients with MCAA treated by microsurgery were analyzed retrospectively. Results Aneurysm was clipped successfully in 19 cases, tumor wall reinforcement was operated in one and resection of aneurysm in 2. The follow up of all patients from 3 months to 24 months showed good recovery in 16 and residue in 5. Conclusions Using transpterion or trans-frontotemporal approach of emergency surgery in patients with hematoma can remove hematoma and clear mass effect. Clip of aneurysm could prevent re-bleeding.