大脑动脉环前部破裂动脉瘤的病理研究

The pathological studies on ruptured aneurysm in anterior Willis circle

目的研究颅内动脉瘤破裂病理改变与临床关系.方法对12例颅内动脉瘤的部位、大小、破口、瘤壁修补、瘤内血栓形成、脑室内积血、脑组织梗死等进行详细的病理学研究.结果12例动脉瘤均位于大脑动脉环前部;16 h以内死亡者目视能见到动脉瘤顶部破口;破裂次数越多,瘤体越大且不规则;破裂动脉瘤修复初期以纤维蛋白为主,间有少许淋巴细胞和红细胞,2～3周后则以胶原纤维为主,辅以新生的毛细血管;12例中5例伴脑室内积血,破入途径不同,脑室积血表现也不一样;3例颈颅内动脉瘤内血栓形成,波及大脑中动脉主干伴发脑梗死.结论破裂的动脉瘤组织学修复需要一定的过程,早期并不牢固.预防再破裂是治疗原则之一;脑梗死的发生机制除迟发性脑血管痉挛外,颈内动脉瘤内血栓形成是常见原因之一;脑室内积血是蛛网膜下腔出血早期的并发症,临床宜密切观察,适时考虑脑室外引流.

Objective To study the relation between pathological changes and clinical aspects of ruptured intracranial aneurysm. Methods Among 12 cases of intracranial aneurysm, the locations and sizes of the aneurysms, ruptured holes, healing of the walls of the aneurysmal sacs, intraventricular hematoma and cerebral ischemic infarction were observed and investigated. Results (1) The 12 cases of aneurysm all located on the anterior part of the circle of Willis. (2) Ruptured holes at the top of aneurysms were seen in the patients who died within 16 hours. (3) Increasing in incidences of ruptures resultea in more irregular and larger size of the aneurysm sac. (4) Ruptured aneurysms were repaired with fibrin initially and a few leukocytic and erythrocytic infiltration. After two or three weeks, collagen fibers became the main component with newly grown capillaries. (5) Ruptured aneurysms with intraventricular hematoma were seen in five cases, the morphology of the clot varied with the site of rupture. (6) In three cases there were thrombi in the intracranial aneurysms, which extended to the middle cerebral arteries resulted in cerebral infarction. Conclusion (1) The initial course of healing of ruptured aneurysm does not provide a stable repair, hence prevention of re-rupture of aneurysm will be one of the therapeutic principles. (2) Both delayed vasospasm and thrombosis in the intracranial aneurysm are the common causes of cerebral infarction. (3) Intraventricular hematoma is the early complication of subarachnoid hemorrhage, external ventricular drainage of the hematoma should be considered if the conservative treatment failed.