大脑中动脉瘤伴侧裂区血肿的诊治策略

Diagnosis and treatment of patients with middle cerebral artery aneurysms combined with intra- Sylvian hematomas

目的探讨大脑中动脉动脉瘤（MCAAs）伴侧裂区血肿的诊断及手术治疗经验。方法回顾性分析解放军总医院神经外科自2006年11月至2011年5月收治的21例MCAAs伴侧裂区血肿患者的临床资料，探讨显微外科手术治疗MCAAs伴侧裂区血肿的经验。结果本组患者中12例行单纯动脉瘤夹夹闭，8例行动脉瘤重新塑形并多枚动脉瘤夹夹毕，1例行动脉瘤孤立、颢浅动脉大脑中动脉架桥术；患者出院时GOS评分：4～5分16例；3分3例；2分1例：1分1例，其中神经功能障碍好转者15例，神经功能障碍无变化4例，神经功能障碍加重者1例．死亡1例。结论MCAAs伴侧裂区血肿，应防止误诊为高血压脑出血，显微外科手术中行载瘤动脉血流监测及体感诱发电位监测可提高治疗效果。

Objective To summarize the diagnosis and treatment experience of patients with middle cerebral artery aneurysms （MCAAs） associated with intra-Sylvian hematomas. Methods The clinical data of 21 patients with ruptured MCAAs associated with intra-Sylvian hematomas （haemorrhage ≥ 20mL）, admitted to our hospital from November 2006 to May 2011, were analyzed retrospectively. Treatment experiences of MCAAs associated with intra-Sylvian hematomas with microsurgery were concluded. Results Among them, 12 patients were performed clipping and 8 were performed resection and clipping. Bypass of superficial temporal artery to middle cerebral artery was performed before occlusion of the afferent artery in 1 patient. When the patients discharged from hospital, their Glasgow outcome scale （GOS） were 4-5 scores in 16 patients, 3 scores in 3, 2 scores in 1 and 1 score in 1; excellent outcomes were achieved in 15 patients, no marked changes in 4 patients, and post-operative complications were observed in 1 patient; 1 perioperative death occurred. Conclusion Ruptured MCAAs combined with intra-Sylvian hematomas should be differed from hypertension hemorrhage of basal ganglia areas; intraoperative Doppler sonography, introperative indocyanine green angiography and neurophysiological monitoring are helpful during the surgical treatment.