开颅手术治疗颅内多发动脉瘤的疗效观察及随访

Craniotomy for multiple intracranial aneurysms: A follow-up study

目的 探讨颅内多发动脉瘤手术治疗的方法、疗效及长期预后。 方法 回顾性分析2010 年4 月- 2012 年12 月本院神经外科因颅内多发动脉瘤而施行开颅手术40 例的临床资料，共94 个动脉瘤，一期手术34 例，二期手术6 例。动脉瘤直接夹闭85 个，孤立2 个，切除1 个，6 个未破裂动脉瘤未予手术处理。根据术后临床症状和影像学改善程度评价手术良好率、病死率，Glasgow 预后分级（Glasgow outcome scale，GOS） 标准评价患者近远期预后。 结果 40 例出院时疗效良好率（GOS 评分4 - 5 分） 为92.25%（37/40），不良率（GOS 评分1 - 3 分）7.25%（3/40），手术相关病死率2.50%（1/40） ；随访期间（8 - 40 个月）疗效良好率（GOS 评分4 - 5 分）91.67%（33/36），不良率（GOS 评分1 - 3 分）8.33%（3/36），病死率2.78%（1/36）。 结论 采取良好的策略是手术治疗颅内多发动脉瘤的关键，并能带来良好的预后。

Objective To study the therapeutic effect and long-term prognosis of multiple intra-cranial aneurysms（MIA） after craniotomy. Methods Clinical data about 40 MIA patients （94 aneurysms） after craniotomy in our hospital from April 2010 to December 2012 were retrospectively analyzed. Of the 40 patients, 34 underwent primary operation and 4 underwent secondary operation. Of the 94 aneurysms, 85 were clipped, 2 were isolated, 1 was removed and 6 non-ruptured didn’t undergo surgery. The success rate and mortality were assessed according to their clinical symptoms and imaging findings. The short- and long-term outcomes of the patients were assessed following the Glasgow outcome scale （GOS）. Results The effective cure rate （GOS score=4-5） was 92.25% （37/40）, the ineffective cure rate （GOS score=1-3） was 7.25% （3/40）, the operation-related mortality was 2.50% （1/40） for the 40 patients at discharge, and was 91.67% （33/36）, 8.33% （3/36）, 2.78% （1/36） for the 40 patients during the 8-40 months followup period. Conclusion Well-designed strategy is the key to surgical treatment of MIA and can result in good outcomes.