颅内动脉瘤显微手术治疗

Microsurgical treatment for intracranial aneurysm

目的 总结 30例颅内动脉瘤中的手术经验。方法 对 30例 (31个 )动脉瘤进行了显微外科手术夹闭 ,分析总结其手术适应证、入路选择及术中操作要点。结果 30例术中 7例动脉瘤破裂出血 ,出院时 2 6例痊愈 (包括 1例多发动脉瘤 ) ;2例残留神经功能障碍 ;2例死亡 (术前HuntⅣ级 )。结论 显微手术夹闭颅内动脉瘤效果良好。对动脉瘤术前Hunt分级Ⅰ～Ⅲ级者应尽早手术 ;Ⅳ、Ⅴ级者应先行脑室外引流 ,辅助尼莫地平等药物治疗 ,待病情平稳再手术。术中防止动脉瘤破裂和破裂后的应急处理至关重要。

Objective To summarize the treatment experience of 30 cases of intracranial aneurysm.Methods Thirty patients(31 aneurysms) receiving operation were clipped.The preoperative treatment,indication of operation,surgical approachs and technique keys during operation were analysed.Results In 30 cases,7 aneurysms were ruptured during the operation.Good outcomes were achieved in 26(including 1 patient with 2 aneurysms located at right A2 and left m2 respectively),2 patients had neurological defects and the other 2 patients died after operation(Hunt's IV degree).Conclusion Microsurgery can have a good effect on intracranial aneurysms.For the patients with hunt's I～Ⅲ degrees,surgical treatment should be done as early as possible,but for the hunt's IV and V patients,drainage of ventricle should be put to the first,and be treated with nimodipine simultanously.Operations can not be done until the conditions of the patients are getting better than ever.It is important to avoid rerupturing of aneurysm and how to deal with it instantly if aneurysm is reruptured during operation.