改良Paine点脑室穿刺协助早期颅内动脉瘤破裂显微手术67例临床分析

Clinical analysis on microsurgery assisted by improved Paine point ventricular puncture in 67 patients with early intracranial aneurysm rupture

目的：探讨早期颅内动脉瘤破裂的显微手术方法。方法经翼点开颅，行改良Paine点脑室穿刺引流脑脊液后，急诊显微手术夹闭破裂的颅内动脉瘤破裂患者67例。39例在颅内动脉瘤破裂后1 d内手术，28例在颅内动脉瘤破裂后2～3 d手术。结果出院时采用格拉斯哥预后评分（GOS）评价疗效，Hunt-HessⅠ～Ⅲ级45例中治愈41例，好转4例；Hunt-HessⅣ～Ⅴ级22例中，治愈6例，好转6例，中残4例，重残1例，死亡5例。结论翼点入路显微手术直接夹闭动脉瘤颈仍是目前最成熟、最可靠的治疗方法，改良Paine点脑室穿刺引流脑脊液能有效减轻早期手术时的急性脑肿胀，是早期急诊显微手术夹闭动脉瘤颈的稳妥、有效辅助方法。

Objective To explore the microsurgery methods in patients with early intracranial aneurysm rupture. Methods Sixty-seven patients with early intracranial aneurysm rupture received the emergency microsurgery after releasing cerebrospinal fluid from improved Paine point via pterion craniotomy. Thirty-nine patients received surgery within 1 d after intracranial aneurysm rupture, and the other 28 patients were within 1-3 d. Results The therapeutic effect was evaluated by Glasgow outcome score （GOS） at discharge. Among the 45 patients with Hunt-Hess Ⅰ-Ⅲ grade, cure was in 41 cases, improved in 4 cases. Among the 22 patients with Hunt-HessⅣ-Ⅴgrade, cure was in 6 cases, improved in 6 cases, moderate disability in 4 cases, severe disability in 1 case, and death was in 5 cases. Conclusions The microsurgery of clipping aneurysm directly via pterion approach is still by far the most reliable treatment. And releasing cerebrospinal fluid from improved Paine points can effectively reduce the acute brain swelling of early operation, which will make it an effective adjuvant therapy to emergency microsurgery of clipping aneurysm.