老年破裂前循环动脉瘤患者的急诊显微手术治疗研究

Acute microsurgical treatment for elderly patients of ruptured cerebral anterior circulating aneurysms

目的探讨采用显微外科手术夹闭老年患者破裂前循环动脉瘤的技术方法和临床疗效。方法回顾性分析都江堰市医疗中心神经外科自2012年5月至2022年12月收治的80例老年破裂前循环动脉瘤患者的病例资料。采用眶上外侧入路、翼点入路或扩大翼点切口开颅,在显微镜下经外侧裂入路,部分患者行Pain's点或改良Pain's点穿刺侧脑室额角,行脑内血肿清除和动脉瘤夹闭,统计动脉瘤夹闭情况。术后6个月随访,使用改良Rankin量表(mRS)来评价患者的临床预后情况。结果本组患者共89个动脉瘤,其中87个(74例)夹闭完全,夹闭成功率97.75%。术后并发症:脑水肿31例(38.75%),经脱水对症治疗好转;血管痉挛38例(47.50%),经扩血管治疗好转;脑积水24例(30.00%),行脑室-腹腔分流术9例,脑积水消失,余15例对症治疗后好转。术后随访6个月,1例患者失访,余79例患者中预后不良(mRS 3~6分)10例,预后良好(mRS 0~2分)69例,预后良好率87.34%。结论采用显微手术技术清除脑内血肿和夹闭动脉瘤的方法对于老年破裂前循环动脉瘤患者具有较高的安全性和有效性。

Objective To investigate the techniques and clinical efficacy of microsurgical clipping for elderly patients with ruptured anterior circulation aneurysms.Methods A retrospective analysis was conducted on the medical records of 80 elderly patients with acute ruptured anterior circulation aneurysms who were treated in the Department of Neurosurgery at Dujiangyan Medical Center from May 2012 to December 2022.The surgical approaches included the supraorbital lateral approach,the pterional approach,or an extended pterional incision.Under the microscope and through the lateral fissure approach,some patients underwent puncture of the lateral ventricle's frontal horn at Pain's point or modified Pain's point,followed by intracerebral hematoma evacuation and aneurysm clipping.The aneurysm clipping status was recorded.Follow up for 6 months after surgery,using the modified Rankin scale(mRS)to evaluate the clinical prognosis of patients.Results There were a total of 89 aneurysms in this group of patients,of which 74 patients(87 aneurysms)were completely clipped,with a success rate of 97.75%.Postoperative complications included cerebral edema in 31 cases(38.75%),which improved after dehydration treatment;vasospasm in 38 cases(47.50%),which improved after vasodilatory treatment;and hydrocephalus in 24 cases(30.00%),with 9 cases undergoing ventriculoperitoneal shunting resulting in the disappearance of hydrocephalus,and the remaining 15 cases improved after symptomatic treatment.At the 6-month postoperative follow-up,one patient was lost to follow-up.Among the remaining 79 patients,10 cases had a poor prognosis(mRS 3-6),and 69 cases had a good prognosis(mRS 0-2),with a good prognosis rate of 87.34%.Conclusion The method of microsurgical technique for evacuating intracerebral hematoma and clipping aneurysms is highly safe and effective in elderly patients with acute ruptured anterior circulation aneurysms.