一期显微手术治疗颅内多发动脉瘤临床观察

Clinical study on 18 cases of single-stage microsurgical treatment of multiple intracranial aneurysms

目的探讨颅内多发动脉瘤中责任动脉瘤的判定、一期手术治疗的手术时机、手术顺序和手术方法以及如何防治血管痉挛,以提高诊治水平。方法对我院神经外科自2010年1月至2012年4月一期手术治疗的颅内多发动脉瘤进行回顾性分析,总结其影像学及临床特点、手术时机和手术方法以及血管痉挛的防治等。结果术后疗效依照GOS评分,18例患者中5分11例、4分5例、3分1例;死亡1例。术后随访行DSA 3例,64排CTA检查12例;14例患者中32个动脉瘤完全夹闭,1例患者有1个动脉瘤瘤颈残余,另1例死亡,2例未行复查。结论术前分析患者临床及影像学特点,明确责任动脉瘤,根据Hunt-Hess临床分级以及GCS评分,可积极一期手术治疗颅内多发性动脉瘤,术中、术后积极防治血管痉挛有助于患者预后。

Objective To investigate the determination of aneurysm of responsibility in the multiple intracranial aneurysms,the timing of single-stage microsurgical treatment,microsurgical skill and strategy as well as how to prevent vasospasm,so to improve the diagnosis and treatment of multiple intracranial aneurysms.Methods We retrospectively analyzed the clinic data of 18 patients,collected from January 2010 to April 2012 in neurological surgery department at our hospital,suffering from multiple intracranial aneurysms and we summarized the imaging and clinical features,timing of surgery,surgical techniques and how to prevent vasospasm.Results After treatment in accordance with GOS score of 18 patients,there were 5 points in 11 cases; 4 points in 5 cases; 3 points in 1 case and 1 case died.Through postoperative follow-up with DSA of 3 cases and 64-slice CTA of 12 cases,32 aneurysms of 14 cases completely disappeared,there were 1 aneurysms with residual aneurysm neck in 1 cases.Otherewise,1 patient died,2 patients didn＇t follow-up.Conclusion Through preoperative analysis of clinical and imaging features,we could determine the responsibility aneurysm.According to Hunt-Hess clinical stage and GCS score we could positively choose one-stage operation to treat multiple intracranial aneurysms.The positive prevention of vasospasm could improve the prognosis of patients.