颅内动脉瘤的显微手术治疗

Microsurgical Treatment of Intracranial Aneurysms

目的探讨颅内动脉瘤的诊断、手术时机和显微手术方法。方法87例颅内动脉瘤均经翼点入路行显微手术夹闭,30例在出血后3d内手术,其余在2周内手术。结果术后DSA造影复查70例,动脉瘤完全消失66例,瘤颈部分残留4例。出院时优74例,良6例,差3例,植物生存1例;死亡3例。Hunt0～Ⅲ级72例中优70例,良2例。Ⅳ～Ⅴ级15例中优4例,良4例,差3例,植物生存1例,死亡3例。结论CT、MRI可为颅内动脉瘤诊断提供重要信息,确诊主要靠DSA检查,但DSA造影阴性,不能否定动脉瘤存在,应结合CTA三维重建作出正确诊断。翼点入路是前循环动脉瘤最佳入路,显微手术夹闭仍是颅内动脉瘤最成熟、可靠的治疗方法之一,主张早期或超早期手术。

Objective To explore the diagnostic procedure, operative time and microsurgical technique in the patients with intracranial aneurysms. Method Of 87 patients with intracranial aneurysms who underwent microsurgical clipping through a pteronal approach, 30 received the operation within 3 days after the cerebral hemorrhage and 57 from 3 days to 2 weeks after the hemorrhage. Results The postoperative DSA examination, which was performed only in 70 patients, showed that the aneurysms disappeared in 66 cases and the neck aneurysms remained partly in 4. Of the 87 patients, 74 gained excellent outcome, 6 good, 3 poor, 1 vegetative state and 3 died. Of 72 patients with Hunt 0～Ⅲ grades, 70 achieved excellent outcome and 2 good. Of 15 patients with Hunt Ⅳ～Ⅴ grades, 4 achieved excellent outcome, 4 good, 3 poor, 1 vegetative state and 3 died. Conclusions CT and MRI can provide important information for diagnosing the intracranial aneurysms, but its definite diagnosis should be made by DSA. DSA combined with 3D-CTA shall diagnose the aneurysms if DSA do not show it. Pteronal approach is the best one of the operation to treat anterior circulation aneurysms. Microsurgical clipping of the intracranial aneurysms still is one of the most reliable, and mature methods. The clipping of the bleeding intracranial aneurysms should be early or ultra-early performed.