颅内前循环破裂动脉瘤早期治疗策略

Early surgical and endovascular treatment of front circulation ruptured aneurysms

目的探讨颅内前循环破裂动脉瘤早期治疗策略。方法 34例颅内前循环破裂动脉瘤患者,根据动脉瘤不同特点和患者情况,急诊或早期选择开颅显微手术夹闭动脉瘤或血管内介入弹簧圈栓塞术进行个性化治疗。结果开颅显微手术夹闭动脉瘤12例,预后良好8例,预后良好率为66.7%,轻残2例,重残1例,植物状态1例,无死亡病例;血管内介入栓塞治疗22例,预后良好16例,预后良好率为72.7%,轻残3例,重残1例,植物状态1例,死亡1例,2组预后情况经统计学处理,P>0.05,差异无统计学意义。结论前循环破裂脑动脉瘤,根据不同情况个性化选择治疗方案,采取急诊或早期开颅显微夹闭术或血管内栓塞治疗,是提高良好预后率,降低病死率和致残率的重要措施。

Objective To explore the safety and efficacy of early＇microsurgical clip and endovascular coil embolization of front circulation ruptured aneurysms. Methods Totally 34 cases of front circulation ruptured aneurysms were early treated with microsurgical clip and endovascular coil embolization respectively according to the different characteristics of aneurysms and the condition of patients. Results Twelve cases with microsurgical clip, good recovery in 8 cases and good recovery rate was 66.7%, moderate disability in 2 eases, severe disability in 1 case, persistent vegetative state in 1 case, no death case. 22 eases with endovascular embollzation, goocl recovery in 16 cases and good recovery rate was 72.7%, moderate disability in 3 ca- ses, severe disability in 1 case, persistent vegetative state in 1 cases, death in 1 case. The good recovery rate, mortality, and disability rate in the two groups had no significant difference（P〉0.05）. Conclusion According to the different characteristics of aneurysms and the condition of patients, early individuation therapy as microsurgical clip and endovaseular coil embolization of front circulation ruptured aneurysms can prevent complications, further decrease the mortality and improve the prognosis.