颅脑损伤合并颅内动脉瘤破裂蛛网膜下腔出血

Head Trauma accompanied with Subarachnoid Hemorrhage Induced by Rupture of Intracranial Aneurism

目的探讨颅脑损伤合并颅内动脉瘤破裂蛛网膜下腔出血的临床特征及治疗。方法回顾分析我院近2年来收治的6例颅脑损伤合并蛛网膜下腔出血病人的临床资料,了解出血类型与头部损伤的关系,提出创伤后蛛网膜下腔出血颅内动脉瘤诊断的可能性。结果6例创伤后蛛网膜下腔出血病人经DSA检查证实为颅内囊状动脉瘤破裂出血,其中前交通动脉瘤2例,后交通动脉瘤3例,大脑中动脉瘤1例,分别行血管内栓塞(4例),开颅动脉瘤夹闭(2例)治疗,无再出血,全部治愈。结论颅脑损伤后应注意合并颅内动脉瘤蛛网膜下腔出血的可能性,尤其是基底池或侧裂池出血者。积极的治疗是提高疗效的关键。

Objective To study the clinical features and therapeutic method of the subarachnoid hemorrhage (SAH) induced by the rupture of intracranial aneurism after head trauma. Methods The clinical and imaging data of 6 patients with head trauma accompanying with intracranial aneurism SAH in our hospital during recent 2 years were analyzed retrospectively. The clinical and imaging features of SAH induced by the ruptune of intracranial aneurismn were compared with that produced by head trauma. Results Of 6 patients with aneurismal SAH after heat trauma, which was diagnosed by digital subtraction angiography (DSA), 2 suffered from anterior communicating artery aneurism, 3 posterior communicating artery aneurism and 1 middle cerebral artery aneurysm. Four patients were treated by Guglielmi detachable coil (GDC) embolization and 2 patients by operatively clipping the aneurisms with craniotomy. All the patients had good clinical outcomes and hemorrhage did not recurred. Conclusions It is should be noted that the SAH after head trauma, especially in the basal cistern or Sylvian fissure, is probably produced by the rupture of intracranial aneurism. The curative effect can be heightened by active surgery and embolization.