大脑中动脉动脉瘤伴脑内血肿的早期显微外科治疗

Early microsurgical treatment for middle cerebral artery aneurysms accompanying intracerebral hematoma

目的探讨大脑中动脉(MCA)动脉瘤伴脑内血肿的临床特征、影像学表现、早期手术治疗及临床疗效。方法回顾分析13例MCA动脉瘤伴脑内血肿早期显微外科治疗患者的临床资料,按Hunt-Hess分级:Ⅱ级2例,Ⅲ级4例,Ⅳ级6例,Ⅴ级1例。64排螺旋CT血管造影(CTA)确诊,动脉瘤均位于MCA分叉部。13例均在动脉瘤破裂出血72 h内行显微手术治疗,其中急诊手术4例。结果动脉瘤夹闭12例,夹闭一侧动脉瘤、另一侧动脉瘤未处理1例。依据GOS判断:优良7例,轻残3例,重残2例,死亡1例。结论早期显微外科手术治疗伴脑内血肿的MCA动脉瘤效果显著,充分的术前评估和良好的显微外科手术技巧是提高疗效的关键。早期手术清除脑内血肿并夹闭动脉瘤可有效预防致命的再出血、改善预后。

【Objective】 To explore the clinical characteristics,neuroradiological manifestation,early microsurgical treatment and clinical effectiveness of middle cerebral artery（MCA） aneurysms resulting in intracerebral hematoma.【Methods】 13 patients with MCA aneurysms resulting in intracerebral hematoma treated by early micrsurgical operation in our hospital were reviewed restrospectively.According to Hunt-Hess classification,2 cases of garde Ⅱ,4 cases of garde Ⅲ,6 cases of garde Ⅳ,1 case of grade Ⅴ.All patients took a definite diagnosis by 64 rows helical CT angiography（CTA）.All aneurysms located in bifurcation.13 patients were performed micrsurgical operation in 72 hours after the aneurysm ruptured and in which 4 patients were performed emergency operation.【Results】 Clipping was carried out in 12 cases,cipping in one side aneurysm and another side was not treated in 1 case.Surgical outcome was good in 7 cases,light disability in 3 cases,severe disability in 2 cases and 1 case died.【Conclusion】 A dramatical effect can be received if microsurgical operation is performed on MCA aneurysms accompanyng intracerebral hematoma in early time.Sufficient preoperative evaluation and good microsurgical techniques are the key to the improvement of clinical effect.Performing the microsurgical operation to evacuate intracerebral hematoma and clip aneurysms in early time can effectively prevent the lethal re-bleeding and improve the prognosis of the patients.