颅内破裂微小动脉瘤的急性期显微手术治疗

Microsurgery for treatment of ruptured intracranial micro aneurysms in emergency period

目的总结颅内破裂微小动脉瘤的急性期显微手术的临床经验。方法 12例自发蛛网膜下腔出血患者经CTA或DSA确诊为颅内微小破裂动脉瘤,其中大脑中动脉动脉瘤5例,大脑前动脉动脉瘤3例,前交通动脉瘤4例,hunt分级Ⅰ~Ⅲ级10例,Ⅳ级2例。在发病3d内行显微手术夹闭,其中6例手术经额锁孔入路完成。术后随访半年。结果 12例动脉瘤均顺利夹闭,8例术后复查头部CTA显示夹闭满意,所有患者随访均无再出血。结论显微手术是治疗颅内微小动脉瘤的重要方式,急性期手术及个体化选择锁孔手术对减少再出血几率、减小损伤具有重要意义。

Objective To summarize clinical experiences of microsurgery for treatment of ruptured intracranial micro aneurysms in emergency period.Methods A series of 12 patients of subarachnoid hemorrhage（SAH） were diagnosed by DSA（3 cases） or CTA（9 cases）.The micro aneurysms including middle artery aneurysms（5 cases） and anterior artery aneurysms（3 cases） and anterior communicating aneurysms（4 cases） were found.The hunt degrees were Ⅰ-Ⅲ degree（10 cases） and Ⅳ degree（2 cases）.All aneurysms were clipped by microsurgery and the key hole approach were applied in 6 cases.All cases were followed up for half a year after operation.Results All aneurysms were clipped successfully.The postsurgical CTA showed good result.No rebleeding occurred in follow-up period.Conclusion The microsurgery is important method for treatment of ruptured intracranial micro aneurysms.Microsurgery in emergency period and key hole approach have important influence to rebleeding and brain injury.