Hunt-Hess Ⅳ、Ⅴ级前循环动脉瘤性蛛网膜下腔出血的超早期显微手术治疗

Ultra-early microsurgery for Hunt-Hess Ⅳ,Ⅴ anterior circulation aneurysmal subarachnoid hemorrhage

目的：探讨超早期显微手术治疗Hunt-HessⅣ、Ⅴ级前循环动脉瘤性蛛网膜下腔出血（a SAH）的临床效果。方法：回顾性分析24例术前Hunt-Hess分级Ⅳ、Ⅴ级前循环动脉瘤性SAH患者的临床资料,患者中Ⅳ级16例,Ⅴ级8例,均在出血后24 h内行显微手术治疗;术后3～6个月用改良Rankin评分量表（mRS）评估预后。结果：23例责任动脉瘤被成功夹闭,1例未能夹闭;术中动脉瘤破裂13例。以mRS评估预后,其中良好（mRS 0～1）7例,轻残（mRS 2）4例,中残（mRS 3）2例,重残（mRS 4）2例,严重残疾（mRS 5）4例,死亡（mRS 6）5例。结论：超早期开颅夹闭联合去骨瓣减压术治疗Hunt-HessⅣ、Ⅴ级前循环动脉瘤能获得良好的治疗效果。

Objective： To discuss the clinical effect of ultra-early microsurgery for Hunt-Hess Ⅳ,Ⅴ anterior circulation aneurysmal subarachnoid hemorrhage（ a SAH）. Method： A retrospective analysis was made of the clinical data of 24 patients with presurgical Hunt-Hess Ⅳ,Ⅴ anterior circulation a SAH,including 16 grade Ⅳpatients and 8 grade Ⅴ patients. A microsurgery was performed on them 24 h after bleeding. A modified Rankin scale（ mRS） was used to assess the prognosis 3-6 months after surgery. Results： Twenty-threee cases of aneurysm were clipped successfully,1 failed and 13 ruptured during surgery. After prognosis assessment with mRS,there were 7 excellent cases（ mRS 0-1）,4 slightly disabled（ mRS 2）,2 moderately disabled（ mRS3）,2 severely disabled（ mRS 4）,4 seriously disabled（ mRS 5） and 5 deaths（ mRS 6）. Conclusion： Ultra-early craniotomy clipping,combined with decompressive craniectomy,has a good therapeutic effect on Hunt-Hess Ⅳ,Ⅴ anterior circulation aSAH.