前循环颅内动脉瘤破裂出血的显微手术治疗

Microsurgery for ruptured intracranial aneurysms in anterior circulation

目的探讨前循环颅内动脉瘤破裂出血的显微手术治疗方法及临床效果。方法回顾性分析清远市人民医院神经外科收治的100例前循环脑动脉瘤破裂出血患者的影像学及手术资料,所有病例均行开颅显微手术夹闭动脉瘤治疗。结果预后按GOS评分分级:良好80例(80%);差13例(13%);死亡7例(7%)。死亡7例中4例为Hunt-HessⅣ级,3例Hunt-HessⅤ级。Ⅴ级存活2例中1例植物生存,1例生活部分自理;Ⅳ级存活23例中2例植物生存,2例生活部分自理,1例完全不能自理。结论采用开颅显微手术夹闭治疗前循环颅内动脉瘤破裂出血可获得满意疗效。对高度怀疑动脉瘤破裂的自发性脑内血肿术前3D-CTA检查可以明确出血原因并指导急诊开颅手术;已有脑疝形成,不具备行3D-CTA或DSA检查条件者,在开颅清除血肿术中对邻近血肿可疑动脉探查,可减少动脉瘤的漏诊率并改善患者的预后。

Objective To discuss method and clinical effect of microsurgery on ruptured intracranial aneurysms in anterior circulation. Methods Imageological and operational data of 100 patients with ruptured intracranial aneurysms in anterior circulation,who were admitted to our hospital,were analyzed retrospectively. The intracranial aneurysms were all treated with microsurgical clipping. Results According to the GOS,good recovery happened in 80 cases（ 80%）,poor recovery in 13（ 13%） and death in 7（ 7%）. Of 7 dead cases,4 were Grade Ⅳ of Hunt-Hess and 3 were Grade Ⅴ.1 case was persistent vegetative state（ PVS） in 2 alive cases which were divided into Grade Ⅴ. In 23 alive cases that were Grade Ⅳ of Hunt-Hess,2 were persistent vegetative state（ PVS）,2 could take care of themselves partly and 1could not take care of himself（ herself）. Conclusions The microsurgical clipping for ruptured intracranial aneurysms in anterior circulation has a curative effect. For spontaneous intracranial hematoma which is highly doubted resulting from ruptured intracranial aneurysms,a preoperative 3D-CTA examination can make clear the reason of bleeding and be a guidance of indicator of emergency operation; And if a patient can not take a 3D-CTA examination because of herniation of brain,possible feeding artery surrounding the hematoma should be explored in craniotomy evacuation of hematoma. So the rate of missed diagnosis can be reduced and recovery can be improved.