颅内动脉瘤显微外科手术163例分析

The experience of microsurgical treatment on 163 cases of intracranial aneurysms

目的 总结颅内动脉瘤显微外科手术的治疗经验。方法 统计近年 2年来显微外科手术夹闭的 16 3例颅内动脉瘤患者的临床资料、手术方式及术后转归。结果 成功夹闭 16 2例 ,5例为栓塞失败后改为手术夹闭。术中过早破裂 31例 ,其中 1例在切开脑膜前破裂 ,未予夹闭。 112例恢复正常工作 (6 9 6 % ) ,轻残 19例 ,重度残废 2 1例 ,死亡 8例 (4 9% ) ,术后脑积水 32例。结论 颅内动脉瘤一旦诊断明确 ,即应积极处理 ,Hunt和Hess 4～ 5级者入院后延迟手术可能减少手术死亡率 ,但在等待期间可能增加再破裂出血的危险 ,因而总死亡率不减少。颅底外科入路及精细的显微操作可减少术中过早破裂。前循环和后循环动脉瘤的术中处理有不同 ,脑积水为最常见的远期并发症 。

Objective To summarize the microsurgical experiences on the treatment of intracranial aneurysm. Methods The clinical materials, surgical procedures and outcome of the clipped intracranial aneurysm within the latest 2 years were reviewed. Results Successfully clip were obtained in 162 cases. The other 5 cases were referred to operation after failure to intravascular embolization. Premature rupture were occurred in 31 cases one case was ruptured before dura incision so the operation was stopped. 8 cases were died (4 9%), 24 cases were severely disabled, 19 cases were mild disabled, postoperative hydrocephalus were occurred in 32 cases, 112 cases recovered to normal work(69 6%). Conclusions Intracranial aneurysm should be treated as soon as the diagnosis was confirmed. Delayed surgery for those with Hunt and Hess grade 4 to 5 can decrease the operative mortaility, but the possibility of aneurysm re rupture may increase, so the total mortality may increase. The combination of skull base surgical approach and meticulous microsurgery can decrease the premature rupture. There were difference in the surgical procedures between. The aneurysms locating at anterior and posterior circulation. Hydrocephalus was the most frequent complication, V P shut must be carried out on time.