Hunt—Hess高分级颅内动脉瘤破裂后的急诊手术治疗

Emergency microsurgery for treatment of Hunt-Hess high grade intracranial aneurysms rupture

目的总结在CT血管造影（CTA）指导下急诊手术治疗Hunt—Hess高分级颅内动脉瘤破裂的经验。方法回顾性分析34例Hunt-Hess高分级的颅内动脉瘤破裂患者的临床资料。患者入院时均行CT和CTA检查。采用显微外科技术临时阻断载瘤动脉，夹闭动脉瘤颈，清除颅内血肿，并去骨瓣减压。结果按格拉斯哥预后量表评分，出院时恢复良好17例，轻残10例，重残3例，死亡4例。结论在紧急情况下CTA可作为诊断颅内动脉瘤的首要影像学方法。对于Hunt—Hess高分级颅内动脉瘤破裂的患者应该积极手术治疗，努力挽救患者生命。

Objective To summarize the experience of emergency microsurgery under the guidance of computed tomographic arteriography （CTA） for treatment of Hunt-Hess high grade intracranial aneurysm rupture. Methods The clinical data of 34 patients with Hunt-Hess high grade intracranial aneurysm rupture were retrospectively analyzed. The CT and CTA were detected in the patients on admission. Emergency operation were all performed. The temporal occlusion of the parent artery, removed intraeranial hematoma and clipping intracranial aneurysms by microsurgicaJ techniques. All patients were removed skull. Results The prognosis was assessed by Glasgow outcome score （GOS）, 17 cases were recovered well, 10 cases were mildly disabled, 3 cases were severely disabled and 4 cases died. Conclusions CTA can be used as the primary diagnosis of intraeranial aneurysm imaging methods under the emergency condition. The patients with Hunt- Hess high grade intracranial aneurysm rupture should make positive surgical treatment to save live.