颅内破裂动脉瘤合并脑内血肿的复合手术治疗

Clinical observation of hybrid surgery on ruptured intracranial aneurysms associated with cerebral hematomas(report of 5 cases)

目的探讨复合手术治疗颅内破裂动脉瘤合并脑内血肿的疗效。方法回顾性分析簧圈栓塞术后行颅骨钻孔血肿腔引流术治疗的5例颅内破裂动脉瘤合并脑内血肿的临床资料。结果 5例头颅CT均表现为典型蛛网膜下腔出血（SAH）合并脑内血肿;DSA发现动脉瘤位于大脑前动脉A2段分叉部1例、大脑前动脉A2段1例、前交通动脉1例、颈内动脉后交通动脉1例、大脑中动脉分叉部1例;术前Hunt-Hess分级Ⅱ级2例,Ⅲ级2例,Ⅳ级1例。引流术后3~4 d血肿大部分引流干净,无再出血、感染及脑梗死。术后6个月GOS评分3分1例,4分1例,5分3例。结论对合并脑内血肿的自发性SAH,首先应考虑动脉瘤破裂出血可能,需尽早行DSA检查明确诊断;复合手术对于部分未发生脑疝又合并脑内血肿的破裂动脉瘤是可行的,能取得良好的疗效。

ObjectiveTo explore the curative effect of hybrid surgery on ruptured intracranial aneurysms associated with cerebral hematomas.Method The clinical data of 5 patients with ruptured intracranial aneurysms associated with cerebral hematomas treated by endovascular embolization combined with burr hole drainage were analyzed retrospectively.Results The CT showed that there was typical subarachnoid hemorrhage associated with cerebral hematomas in all the patients who were diagnosed as intracranial aneurysms by DSA including 1 aneurysm of the bifurcation of A_2 segment of anterior cerebral artery, 1 aneurysm of A_2 segment of anterior cerebralartery, 1 anterior communicating artery aneurysm, 1 posterior communicating artery aneurysm, and 1 aneurysm of the bifurcation of middle cerebral artery. The condition belonged in Hunt-Hess grade Ⅱ in 2 patients, grade Ⅲ in 2 and grade Ⅳ in 1. Most of the hematomas were successfully drained from 3 to 4 days after operation. There was no re-bleeding, infection or cerebral infarction during the hospital stay. The following up of 6 months after the operation showed that GOS scores were 3 in 1 patient, 4 in 1 and 5 in 3.Conclusions For spontaneous subarachnoid hemorrhage associated with intracranial hematomas, we should first consider the possibility of aneurysm rupture and DSA examination should be carried out as early as possible. Hybrid surgery is feasible for the patients with the ruptured aneurysms associated with intracranial hematomas but without cerebral hernia.