老年人颅内动脉瘤破裂的早期显微外科手术治疗

Clinical research on the early surgical treatment of rupture intracranial aneurysms in elderly patients

目的探讨老年人颅内动脉瘤破裂出血的早期显微外科手术治疗的疗效。方法回顾性分析42例60岁以上早期行显微外科手术夹闭动脉瘤颈的老年颅内动脉瘤病人的疗效。结果术后迟发性有症状性血管痉挛和脑梗死9例,至出院时完全恢复5例;GOS评分良好31例,较差7例,死亡4例,其中2例因脑血管痉挛和脑梗死,2例因肺部感染、多器官功能衰竭。结论开颅手术应根据患者Hunt-Hess分级,生理状况、动脉瘤的特征及患者和(或)病人意愿为依据,争取早期行开颅手术夹闭动脉瘤。

[Objective] To observe the efficacy of early microsurgical operation treatment of rupture intracranial aneurysms in elderly patient. [Methods] The data on early microsurgical operation treatment of 42 over 60 year old patients were retrospectively reviewed. [Results ] 9 patients presented with symptomatic vasospasm after operation in the craniotomy group, 5 of them had a good outcome after discharge. 4 patients died, 2 of them died because of delayed cerebral infarction, and 2 died of pulmonary infection and multiple organ failure. [ Conclusions ] The early microsurgical operation treatment should be decided according to the Hunt-Hess score, the general status of patients, pathological features of aneurysms and expectation from the patients and their family members. And the surgery should be performed as early as possible.