急诊手术治疗大脑中动脉动脉瘤破裂合并脑内血肿

Emergent microsurgical management of ruptured middle cerebral artery aneurysms associated with intracerebral hematomas

目的总结大脑中动脉动脉瘤破裂合并脑内血肿的急诊手术方法及疗效。方法急诊手术治疗大脑中动脉动脉瘤破裂合并脑内血肿患者13例,术中均先清除部分血肿减压,然后采用经侧裂近端-远端入路行动脉瘤夹闭术。8例患者术前行CTA检查明确动脉瘤,5例患者直接手术探查发现动脉瘤。结果 13例患者均在血肿清除同时成功夹闭动脉瘤,术后死亡3例,重残2例,中残2例,6例预后良好。结论大脑中动脉动脉瘤破裂合并脑内血肿急诊手术能有效改善预后。

Objective To summarize the experience and effectiveness in emergent microsurgical treatment of ruptured middle cerebral artery aneurysms （MCAA） associated with intracerebral hematomas （ICH）. Methods Thirteen patients with MCAA associated with ICH were operated on emergently. After hematomas were partially evacuated to decrease intracerebral pressure, proximal to distal lateral fissure approach was used to explore and clip aneurysms in all patients. Preoperative three-dimensional CT angiography （3D-CTA） were performed in 8 patients to reveal aneurysms. Another 5 patients underwent urgent surgeries after CT scan because of critical illness. Results All aneurysms were clipped after hematoma evacuation. Follow-up showed good recovery in 6 cases, moderate disability in 2, severe disability in 2 and death in 3 cases （ all belong to Hunt＆Hess grade V ）. Conclusion Ruptured middle cerebral artery aneurysms associated with intracerebral hematomas are fatal. Emergent surgery is helpful to improve the outcome of these patients.