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Aneurysm Clipping and Outcome for Hunt &Hess Grade 4, 5 Subarachnoid Hemorrhage—A Literature Review
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作者 Kalyan Bikram Shah Lukui Chen +2 位作者 Li Bing Qian Sudeep Shrestha Sandip Kumar Jaiswal 《Open Journal of Modern Neurosurgery》 2018年第2期215-232,共18页
“Subarachnoid Hemorrhage is non-traumatic nasty bleeding into the subarachnoid area, the territory between the arachnoid and the piamater of the central nervous system showing prompt developing signs of neurological ... “Subarachnoid Hemorrhage is non-traumatic nasty bleeding into the subarachnoid area, the territory between the arachnoid and the piamater of the central nervous system showing prompt developing signs of neurological sequelae”. It is one among the neurological emergencies which is a very distressing cerebrovascular disease with complicated mechanisms that risks brain perfusion and its function, having higher morbidity and mortality rates. Its mortality rate is still ranged between 8.3% and 66.7%, with noticeable regional variations, beside recent advances in treatment approaches. The incidence of SAH among the population of 2 - 22.5/100,000 was reported with a minimum of 60% of aneurysm ruptures occurring amid ages of 40 and 60 years with 3:2 male:female ratio. The rupture risks for unruptured aneurysms are increased by the issues like present smokers, larger size of aneurysm, and amid young population. The surgical treatment decision should be contemplated upon factors such as aneurysm’s size, aneurysm’s location, patient’s illness history, and surgeon’s operative experiences. Latest technical progresses in imaging techniques, increased consideration of illness history, more awareness of incidences of aneurysms and use of micro neurosurgery, have raised the chance for detection of subarachnoid hemorrhage (SAH) and possible better outcomes with surgical management. Factors that may affect outcome include age, size and site of aneurysm, interval between ictus and surgery, CT Fisher Grade & Hunt and Hess Grading earlier to surgery, & Glasgow Coma Scale at the while of discharge. The studies here support the wide spread concept that surgical clipping of SAH for Hunt and Hess Grade 4, 5 SAH, which is also considered as poor Grade SAH stipulates an effective treatment if done earlier provides better outcome. 展开更多
关键词 aneurysm SUBARACHNOID Hemorrhage HUNT & HESS Grading clipPING OUTCOME
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Applications of multislice CT angiography in the surgical clipping and endovascular coiling of intracranial aneurysms 被引量:2
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作者 Wenhua Chen Yilin Yang +4 位作者 Wei Xing Ya Peng Jianguo Qiu Zhongming He Qi Wang 《The Journal of Biomedical Research》 CAS 2010年第6期467-473,共7页
Prompt diagnosis and therapy of aneurysms are critical for patients with nontraumatic subarachnoid hemorrhage (SAH).The aim of our study was to assess the clinical usefulness of multislice computed tomography angiog... Prompt diagnosis and therapy of aneurysms are critical for patients with nontraumatic subarachnoid hemorrhage (SAH).The aim of our study was to assess the clinical usefulness of multislice computed tomography angiography (CTA) in the surgical and endovascular treatment of intracranial aneurysms.A total of 195 cases with 206 intracranial aneurysms underwent CTA.Fifty (24%) aneurysms underwent surgical clipping while 156 (76%) aneurysms underwent endovascular coiling.In the five missed aneurysms at digital substraction angiography and the nine aneurysms with mass intracerebral hematomas,surgical treatment was successfully performed based on 16-slice CTA alone,and the other 36 aneurysms were clipped on the main basis of the CTA.The intraoperative findings correlated well with the CTA findings and all aneurysms were clipped successfully.Sixteen-slice CTA image information has been shown to determine the choice of aneurysm therapy and assist the surgical and endovascular treatment of intracranial aneurysms. 展开更多
关键词 intracranial aneurysm computed tomography angiography clipPING COILING
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Surgical Clipping of a Basilar Tip Aneurysm: Case Report and Literature Review
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作者 Médard Kakou Alban Slim Mbende +1 位作者 Fulbert Kouakou Phanré Doua 《Open Journal of Modern Neurosurgery》 2017年第3期55-64,共10页
Basilar tip aneurysms account for 5% - 8% of all intracranial aneurysms. They are known to rupture more frequently than aneurysms in other locations. Surgical clipping of basilar apex aneurysms however challenging;rem... Basilar tip aneurysms account for 5% - 8% of all intracranial aneurysms. They are known to rupture more frequently than aneurysms in other locations. Surgical clipping of basilar apex aneurysms however challenging;remains the treatment of choice in Ivory Coast due in part, to multiple technical barriers. A 60-year-old right-handed patient presented to our Neurosurgical Unit in February 2nd 2013 after a sudden onset of altered consciousness. Neurological examination revealed both an upper motor neuron and meningeal syndromes with a Glasgow Coma Scale of 12. Brain NECT scan and a subsequent brain CT angiography showed a subarachnoid haemorrhage and a 3.8 mm (height) × 5.2 mm (width) basilar tip aneurysm respectively. Surgical clipping of the aneurysm was indicated but due to multiple technical barriers, surgery was delayed and the patient underwent surgery after the critical vasospasm period. The patient developed a hospital acquired pneumonia after surgery and was successfully treated with antibiotics. Since her discharge, she has been asymptomatic. We sought to report this case of a basilar apex aneurysm successfully occluded with non-ferromagnetic SUGITA clips and to share our experience of clipping these lesions through the frontotemporal approach. The patient was informed that non identifying information from the case would be submitted for publication, and she provided consent. 展开更多
关键词 BASILAR ARTERY BASILAR TIP aneurysm Surgical clipPING
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Three-Dimensional Cerebral Aneurysm Models for Surgical Simulation and Education—Development of Aneurysm Models with Perforating Arteries and for Application of Fenestrated Clips
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作者 Tatsuya Ishikawa Akio Morita +1 位作者 Takanori Fukushima Hidenori Ono 《Open Journal of Modern Neurosurgery》 2014年第2期59-63,共5页
We modified a three-dimensional cerebral aneurysm model for surgical simulation and educational demonstration. Novel models are made showing perforating arteries arising around the aneurysm. Information about perforat... We modified a three-dimensional cerebral aneurysm model for surgical simulation and educational demonstration. Novel models are made showing perforating arteries arising around the aneurysm. Information about perforating arteries is difficult to obtain from individual radiological data sets. Perforators are therefore reproduced based on previous anatomical knowledge instead of personal data. Due to their fragility, perforating arteries are attached to the model using hard materials. At the same time, hollow models are useful for practicing clip application. We made a model for practicing the application of fenestrated clips for paraclinoid internal carotid aneurysms. Situating aneurysm models in the fissure of a brain model simulates the real surgical field and is helpful for educational demonstrations. 展开更多
关键词 THREE-DIMENSIONAL Cerebral aneurysm Model clipPING Surgery Simulation PERFORATING Artery FENESTRATED clip
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Application of 3D–DSA simulated surgical path in intracranial aneurysm clipping surgery
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作者 Jun Sun Zhiwei Li +4 位作者 Chuan Lu Xiandong Chen Maohua Chen Huajun Ba Qun Lin 《Chinese Neurosurgical Journal》 CSCD 2018年第1期22-25,共4页
Background:Intracranial aneurysm is a common cerebrovascular disease, which cause wide concern by neurosurgeons. The 3D-DSA images simulated surgical path may improve the success rate of operation in bridging surgery ... Background:Intracranial aneurysm is a common cerebrovascular disease, which cause wide concern by neurosurgeons. The 3D-DSA images simulated surgical path may improve the success rate of operation in bridging surgery of emergency ruptured intracranial aneurysms.Methods: Eighteen patients with intracranial ruptured aneurysms that underwent craniotomy clipping surgery from January 2015 to January 2016 were included in this study. All patients were diagnosed with ruptured aneurysm and SAH, and 3 of them had concomitant hematoma. All patients were clipped in 3 days after diagnosis. Before clipping, the relevant information and data of the 3D-DSA images simulated surgical path were observed to guide intracranial aneurysm clipping surgery.Results: According to the information of the 3D-DSA images simulated surgical path, all aneurysms were clipped successfully. 1 patient died of vessel spasm, and the remaining patients recovered well.Conclusions: The 3D-DSA images simulated surgical path could provide surgeons with a lot of information in bridging surgery of emergency ruptured intracranial aneurysms,and is significant to improve the success rate of operation. 展开更多
关键词 Bridging SURGERY INTRACRANIAL aneurysmS 3D-DSA clipping SURGERY SIMULATED SURGICAL PATH
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Vasospasm as a Complication after Aneurysmal Rupture and Its Relation with Surgical Clipping and Endovascular Coiling among a Georgian Sample
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作者 Maha Kassem Lama Alchaar +10 位作者 Ahmed Abdelkader Mohammad Eghbalbakhtiary Koka Gogichashvili Mirza Khinikadze Shriniwas Chandrasekhar Yadav Astha Zambani Sonali Mankar Mahalakshmi Jayasankar Mohamed Abdelsattar Atta Ismail Ali Sarah Ibrahim Natia Iashvili 《World Journal of Neuroscience》 CAS 2022年第3期153-162,共10页
Background: Potentially lethal, aneurysmal subarachnoid hemorrhage has a bad prognosis for many individuals. Over the past few decades, endovascular and surgical interventions have been developed, including surgical c... Background: Potentially lethal, aneurysmal subarachnoid hemorrhage has a bad prognosis for many individuals. Over the past few decades, endovascular and surgical interventions have been developed, including surgical clipping, and endovascular coiling. Patients who have aSAH are also susceptible to delayed cerebral ischemia and cerebral vasospasm. The aim of this study is to compare the outcome of endovascular coiling with surgical clipping in patients with SAH, specifically in relation to prevalence of vasospasm, in the country of Georgia. Method: In this study, we present a retrospective review of the outcomes of 217 patients with acute subarachnoid hemorrhage who underwent endovascular coiling or surgical clipping. The data were gathered from patients who are admitted to New Vision University Hospital and Caucasus Medical Center in Tbilisi, Georgia, between 2017 and 2022. Results: Vasospasm was prevalent in 217 of the patients who had aneurysmal rupture when they first appeared. Endovascular coiling or surgical clipping was used to treat aneurysmal rupture. In our sample, 24.81 percent of patients who underwent coiling experienced vasospasm after 14 days, compared to 31.25 percent of patients who underwent clipping. After endovascular coiling and surgical clipping, the severity of vasospasm was only slightly different, according to Lindegaard ratios. Finally, 32 patients (23.35 percent) died after coiling whereas 55 patients (68.75 percent) died within three decades of clipping. Conclusion: After 5 years of data collection, this study has demonstrated the most favorable option for treatment is endovascular coiling. However, the treatment choice takes multiple factors into account, and clipping is not ideal for some ruptured aneurysms. Despite the fact that endovascular coiling is usually successful and minimally invasive, complications can occur and additional monitoring and potential surgical intervention are indicated. 展开更多
关键词 aneurysmS Subarachnoid Hemorrhage Surgical clipping Endovascular Coiling VASOSPASM
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Clipping versus Coiling in Ruptured Aneurysms of the Anterior Cerebral Circulation
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作者 Farrag Mohammad Takashi Horiguchi +1 位作者 Katsuhiro Mizutani Kazunari Yoshida 《Open Journal of Modern Neurosurgery》 2020年第1期88-104,共17页
Objective: To evaluate and compare the outcomes of microsurgical clipping and endovascular coiling of ruptured anterior cerebral circulation aneurysms. Methods: The current study retrospectively included 61 patients p... Objective: To evaluate and compare the outcomes of microsurgical clipping and endovascular coiling of ruptured anterior cerebral circulation aneurysms. Methods: The current study retrospectively included 61 patients presented with subarachnoid hemorrhage (SAH), treated by clipping or coiling for ruptured aneurysms located in anterior circulation. Anatomic outcome and post-operative ischemic events were evaluated. The primary clinical outcomes were evaluated as operative complications while the secondary clinical outcome was evaluated by modified Rankin scale (mRS) at discharge. Results: Of 61 ruptured aneurysms, 47 and 14 were treated by surgery and coiling, respectively. The average follow-up duration was 19.1 ± 18.6 months for clipping and 21.7 ± 14.8 months for coiling. Complete occlusion was greater in surgery group (80.8%) than endovascular group (21.4%). Re-growth occurred in 2 cases of the coiling group only. Ischemic events were encountered in both groups;silent ones were higher in coiling group (21.4%) than in clipping group (6.3%), while symptomatic ones were higher in the clipping group (49%). Good outcome (mRS 0 - 2) was 51% and 71.4% after clipping and coiling respectively. Postoperative hospital period was longer after clipping (P = 0.04). Conclusions: For anterior circulation ruptured aneurysms, both treatments are feasible, coiling showed lower rate of morbidity while clipping results were better regarding durability and recurrence. Coil embolization may be preferred, which is the current point proved by the RCT like ISAT, but if you choose the patients carefully and find out the optimal candidate for the clipping, the clipping is still enough feasible as a mainstream. 展开更多
关键词 ANTERIOR Circulation SAH clipPING COILING RUPTURED aneurysmS
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Clipping of Lateral Posterior Choroidal In-traventricular Aneurysm Related to Ruptured Temporal Arteriovenous Malformation: Case Report
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作者 Jaime López Calle Rommel Arbulú Zuazo +5 位作者 Ronald Pascual Valverde Walter Colunga Cáceres Katya Chávez Barboza César Fustamante Torres Yosimar Coasaca Tito Luis Muñoz Chumbes 《Open Journal of Modern Neurosurgery》 2016年第1期9-15,共7页
Background: Intraventricular cerebral aneurysms are uncommon brain vascular disease in general population. The previous reported cases point with more frequency to Moyamoya disease as the main factor to originate aneu... Background: Intraventricular cerebral aneurysms are uncommon brain vascular disease in general population. The previous reported cases point with more frequency to Moyamoya disease as the main factor to originate aneurysms in the choroidal arteries. Those related to an AVM are even rarer and only two cases have been previously reported. Aim: To discuss the unusual location of this aneurysm, its relationship to other conditions and the type of treatment. Case Presentation: We present the case of a patient with a non-ruptured intraventricular aneurysm of lateral posterior choroidal artery related to a ruptured right temporal arteriovenous malformation, who was successfully treated by clipping immediately, after resection of the malformation. Conclusion: Intraventricular choroidal artery aneurysm is a rare pathology. Its deep location makes the treatment challenging but mandatory due to the high probability of bleeding, especially those flow-related to an arteriovenous malformation. 展开更多
关键词 Posterior Choroidal Artery aneurysm Arteriovenous Malformation clipPING
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颅内动脉瘤破裂患者显微动脉瘤夹闭手术时机对疗效及预后的影响
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作者 刘健 刘丛 《中国实用神经疾病杂志》 2024年第7期849-852,共4页
目的探究显微动脉瘤夹闭手术时机对颅内动脉瘤(IA)破裂患者临床疗效和预后的影响。方法搜集2020-05—2023-05内江市第一人民医院治疗的96例颅内动脉瘤破裂患者的临床资料,根据患者发病至手术时间分为超早期组(24 h内)49例和早期组(24~72... 目的探究显微动脉瘤夹闭手术时机对颅内动脉瘤(IA)破裂患者临床疗效和预后的影响。方法搜集2020-05—2023-05内江市第一人民医院治疗的96例颅内动脉瘤破裂患者的临床资料,根据患者发病至手术时间分为超早期组(24 h内)49例和早期组(24~72 h)47例,比较2组患者临床疗效、并发症和预后情况。结果2组患者手术完全夹闭率和术中IA再破裂率比较差异无统计学意义(91.84%比85.11%,6.12%比4.26%,P>0.05)。超早期组术前IA再破裂发生率低于早期组(0比12.77%,P<0.05),并发症发生率低于早期组(16.33%比34.04%,P<0.05),预后良好率高于早期组(85.71%比68.09%,P<0.05)。结论在IA破裂24 h内的超早期进行显微动脉瘤夹闭手术疗效优于发病后24~72 h,超早期手术能够降低术前IA再破裂风险,减少并发症,改善患者预后。 展开更多
关键词 颅内动脉瘤 动脉瘤破裂 显微动脉瘤夹闭 手术时机 预后
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3D-Slicer重建CTA在颅内动脉瘤夹闭术后随访中的应用
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作者 苏慧 黄舒心 +4 位作者 吴玥 姬将 文萌萌 薛晓娟 肖新广 《中国CT和MRI杂志》 2024年第3期9-11,共3页
目的 探究基于3D-Slicer后处理CT血管造影(CTA)在颅内动脉瘤夹闭术后复查中的应用价值。方法 回顾性收集57例动脉瘤夹闭术患者的术后CTA影像资料,图像后处理方法包括多平面重组(MPR)、容积再现(VR)及最大密度投影重组(MIP),并与放射科... 目的 探究基于3D-Slicer后处理CT血管造影(CTA)在颅内动脉瘤夹闭术后复查中的应用价值。方法 回顾性收集57例动脉瘤夹闭术患者的术后CTA影像资料,图像后处理方法包括多平面重组(MPR)、容积再现(VR)及最大密度投影重组(MIP),并与放射科工作站处理结果进行定性、定量对比,评价其临床应用价值。结果 57例患者69个动脉瘤共夹闭63个,术后CTA除5例图像质量不佳,余均可轻清晰显示瘤夹位置、残余瘤体、载瘤动脉瘤通畅性;术后CTA见2例夹闭不全,2例新发动脉瘤,9例血管广泛痉挛显影浅淡;脑出血3例,脑积水5例,脑梗死1例,以上结果与放射科工作站一致。两种方法重建3D-CTA对于夹闭后载瘤动脉瘤管径大小呈现无统计学差异,且一致性高。结论 3D-Slicer软件对于夹闭术后CTA的图像后处理结果令人满意,可作为一种备选的工具服务于临床。 展开更多
关键词 颅内动脉瘤夹闭术 血管造影术 图像后处理 3D-Slicer
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高压氧联合尼莫地平在接受颅内动脉瘤夹闭术患者中的效果
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作者 罗越岭 袁波 谭占国 《河南医学研究》 CAS 2024年第11期2020-2024,共5页
目的 探讨颅内动脉瘤(IA)夹闭术患者术后接受高氧与尼莫地平治疗的效果。方法 选取2018年1月至2023年1月在漯河市源汇区人民医院接受IA夹闭术的90例患者作为研究对象,采用随机数字表法分为观察组(45例)和对照组(45例)。术后对照组接受... 目的 探讨颅内动脉瘤(IA)夹闭术患者术后接受高氧与尼莫地平治疗的效果。方法 选取2018年1月至2023年1月在漯河市源汇区人民医院接受IA夹闭术的90例患者作为研究对象,采用随机数字表法分为观察组(45例)和对照组(45例)。术后对照组接受尼莫地平治疗,观察组在对照组基础上接受高压氧治疗。比较两组患者不同时点脑血流动力学指标、神经功能损伤情况、脑血管痉挛(CVS)发生情况、预后、生活质量及日常生活能力。结果 治疗后第14天,观察组大脑中动脉平均血流速度(MFV)、收缩期最大峰值流速(SPV)均高于对照组(P<0.05),而血管阻力指数(RI)及搏动指数(PI)低于对照组(P<0.05),CVS发生率低于对照组(P<0.05),简明健康状况调查表(SF-36)评分及日常生活能力评定量表(ADL)评分高于对照组(P<0.05),格拉斯哥结局量表(GOS)预后情况优于对照组(P<0.05);治疗后第7、14天,观察组美国国立卫生研究院卒中量表(NIHSS)评分低于对照组(P<0.05)。结论 高压氧联合尼莫地平可改善IA夹闭术患者术后脑血流及神经功能,并降低脑血管痉挛发生率,改善患者预后,提高生活质量及日常生活能力。 展开更多
关键词 高压氧 尼莫地平 颅内动脉瘤夹闭术 脑血流 神经功能
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前交通动脉动脉瘤112例诊治真实世界数据分析:单中心报告
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作者 唐必英 李钢 +4 位作者 刘珍 乔卫东 王辉 刘成业 肖仕和 《中国微侵袭神经外科杂志》 CAS 2024年第4期203-208,共6页
目的对前交通动脉动脉瘤(anterior communicating artery aneurysm,ACoAA)病例资料进行真实世界数据(real world data,RWD)分析,总结救治经验。方法回顾性分析112例ACoAA病例资料。男69例,女43例,年龄30~80岁、平均(45.00±11.05)... 目的对前交通动脉动脉瘤(anterior communicating artery aneurysm,ACoAA)病例资料进行真实世界数据(real world data,RWD)分析,总结救治经验。方法回顾性分析112例ACoAA病例资料。男69例,女43例,年龄30~80岁、平均(45.00±11.05)岁。发生蛛网膜下腔出血就诊110例,未破裂就诊2例。行开颅夹闭66例,血管内介入治疗46例,其中应用支架辅助栓塞5例。统计病人的人口学资料、基础疾病、个人史、家族史、入院状况及影像学资料、动脉瘤解剖学特征、病人预后等资料。结果依据改良Rankin量表(modified Rankin Scale,mRS)评分:良好(mRS 0~2分)82例,残疾(mRS 3~5分)22例,死亡(mRS 6)8例。RWD将预后不良的相关因素,纳入有序多分类Logistic回归分析,显示年龄与饮酒史是ACoAA术后预后的独立危险因素,病人居住地、高血压病史及不同治疗术式(开颅夹闭和栓塞治疗)不是病人预后的独立危险因素。结论ACoAA确诊后接受积极治疗(开颅夹闭或栓塞治疗),病人术后恢复良好率较高。ACoAA不良预后可能与年龄、饮酒等因素相关。 展开更多
关键词 颅内动脉瘤 前交通复合体 真实世界数据 动脉瘤夹闭术 动脉瘤栓塞术
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开颅夹闭手术和介入栓塞术治疗颅内动脉瘤破裂的临床效果分析 被引量:1
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作者 谭皓 唐权伟 +4 位作者 李世权 吴学平 侯成林 戴正军 秦保平 《中国社区医师》 2024年第7期26-28,共3页
目的:探讨开颅夹闭手术和介入栓塞术治疗颅内动脉瘤破裂的临床效果。方法:选取2018年3月—2023年3月重庆市石柱土家族自治县人民医院收治的130例颅内动脉瘤破裂患者作为研究对象,采用随机数字表法分为对照组(n=83)和研究组(n=47)。对照... 目的:探讨开颅夹闭手术和介入栓塞术治疗颅内动脉瘤破裂的临床效果。方法:选取2018年3月—2023年3月重庆市石柱土家族自治县人民医院收治的130例颅内动脉瘤破裂患者作为研究对象,采用随机数字表法分为对照组(n=83)和研究组(n=47)。对照组实施开颅夹闭手术,研究组实施介入栓塞术。比较两组临床效果、临床指标、并发症情况。结果:两组治疗效果总优良率比较,差异无统计学意义(P>0.05)。研究组手术时间、住院时间短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.001)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论:开颅夹闭手术和介入栓塞术治疗颅内动脉瘤破裂的临床效果相当,但介入栓塞术手术时间短,手术创伤小,更利于患者术后康复。 展开更多
关键词 破裂颅内动脉瘤 开颅夹闭手术 介入栓塞治疗
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颅内动脉瘤夹闭手术患者医院感染病原菌特点及危险因素分析
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作者 苏微微 吴伟 赖翠翠 《中外女性健康研究》 2024年第9期166-170,共5页
目的:调查动脉瘤夹闭手术患者医院感染情况,分析医院感染相关危险因素。方法:回顾性调查某三级甲等综合医院神经外科2019年1月1日至2021年12月31日行颅内动脉瘤夹闭手术的282例患者的临床资料,对其临床资料进行单因素及多因素分析。结果... 目的:调查动脉瘤夹闭手术患者医院感染情况,分析医院感染相关危险因素。方法:回顾性调查某三级甲等综合医院神经外科2019年1月1日至2021年12月31日行颅内动脉瘤夹闭手术的282例患者的临床资料,对其临床资料进行单因素及多因素分析。结果:282例动脉瘤夹闭手术患者医院感染发生率为21.63%,医院感染例次发生率为24.11%。单因素分析显示,年龄、动脉瘤破裂、术前GCS评分、术前HH评分、侵入性操作、术后入住ICU、住院时间、深静脉血栓、头部引流管留置时间、手术持续时间10个因素对动脉瘤夹闭手术患者发生医院感染影响显著,具有统计学差异(P<0.05);多因素分析显示,入住ICU、年龄大于65岁、腰椎穿刺及腰大池引流是动脉瘤夹闭手术患者发生医院感染的独立危险因素。结论:动脉瘤夹闭手术患者医院感染发生率高,感染的发生是多种因素共同作用的结果。其中,入住ICU、年龄大于65岁、腰椎穿刺及腰大池引流是动脉瘤夹闭手术患者发生医院感染的独立危险因素。 展开更多
关键词 动脉瘤 开颅夹闭手术 医院感染 病原菌
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血管内介入栓塞术对蛛网膜下腔出血患者的疗效及预后的影响
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作者 王丽娜 高涛 《黑龙江医学》 2024年第9期1037-1040,共4页
目的:观察血管内介入栓塞术治疗动脉瘤破裂所致蛛网膜出血(SAH)的效果及对患者预后的影响。方法:回顾性分析2021年1月-2021年12月河南科技大学第一附属医院收治的122例动脉瘤破裂SAH患者临床资料。采用电脑随机分组法,将其分为对照组(61... 目的:观察血管内介入栓塞术治疗动脉瘤破裂所致蛛网膜出血(SAH)的效果及对患者预后的影响。方法:回顾性分析2021年1月-2021年12月河南科技大学第一附属医院收治的122例动脉瘤破裂SAH患者临床资料。采用电脑随机分组法,将其分为对照组(61例,开颅夹闭术治疗)和观察组(61例,血管内介入栓塞术治疗),比较两组患者的治疗效果,并通过术后为期6个月的短期随访评估并对比患者的预后情况。结果:术后,观察组的高迁移率族蛋白1(HMGB1)、单核细胞趋化蛋白-1(MCP-1)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平均低于对照组,差异有统计学意义(t=10.964、2.674、3.550、6.213,P<0.05);术后,血管内皮素-1(ET-1)、皮质醇(Cor)、去甲肾上腺素(NE)、心率血压乘积(RPP)均低于对照组,差异有统计学意义(t=11.920、19.258、15.277、4.007,P<0.05);观察组的格拉斯哥预后指数(GOS)、远期生活质量评估(KPS)高于对照组,改良Fisher量表(mFS)低于对照组,差异有统计学意义(t=27.995、18.279、28.224,P<0.05);术后不良事件发生率低于对照组,差异有统计学意义(χ^(2)=6.100,P<0.05)。结论:相较于常规动脉瘤夹闭术而言,血管内介入栓塞术治疗SAH的效果更佳,对缓解患者脑组织炎症反应、术后应激反应、改善预后并减低术后并发症发生风险均有积极意义。 展开更多
关键词 动脉瘤破裂 蛛网膜下腔出血 动脉瘤夹闭术 血管介入栓塞术 预后情况
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血管内微导管介入治疗脑动脉瘤的效果分析
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作者 胡赞 姚永新 《中国社区医师》 2024年第9期29-31,共3页
目的:分析血管内微导管介入治疗脑动脉瘤的效果。方法:选取2020年2月—2023年4月湘潭市中心医院收治的脑动脉瘤患者70例作为研究对象。采用随机数字表法分为试验组、参照组,各35例。参照组采用夹闭手术治疗,试验组采用血管内微导管介入... 目的:分析血管内微导管介入治疗脑动脉瘤的效果。方法:选取2020年2月—2023年4月湘潭市中心医院收治的脑动脉瘤患者70例作为研究对象。采用随机数字表法分为试验组、参照组,各35例。参照组采用夹闭手术治疗,试验组采用血管内微导管介入治疗。比较两组治疗效果。结果:试验组治疗总有效率高于参照组,差异有统计学意义(P=0.003)。试验组手术时间、住院时间短于参照组,术中出血量少于参照组,差异有统计学意义(P<0.001)。试验组并发症总发生率低于参照组,差异有统计学意义(P=0.046)。治疗后,两组核因子κB、血管内皮生长因子、血清可溶性细胞间黏附分子-1水平低于治疗前,且试验组低于参照组,差异有统计学意义(P<0.05)。结论:血管微导管介入治疗脑动脉瘤的效果较好,可缩短手术时间,减少术中出血量,改善血清指标,降低并发症发生率,促进患者康复。 展开更多
关键词 血管内微导管介入 脑动脉瘤 夹闭手术
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显微镜下开颅夹闭前交通动脉瘤术后迟发性脑梗死的影响因素分析
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作者 封暴 余意 +4 位作者 夏浩 吴俊逸 于佩名 任寅 朱玉辐 《医学研究杂志》 2024年第7期136-140,共5页
目的探讨显微镜下行开颅夹闭前交通动脉瘤手术后迟发性脑梗死的影响因素。方法回顾性分析2020年1月~2023年7月于徐州医科大学附属医院行显微镜下开颅夹闭前交通动脉瘤手术治疗患者的临床资料。采用单因素和多因素Lo-gistic回归分析评价... 目的探讨显微镜下行开颅夹闭前交通动脉瘤手术后迟发性脑梗死的影响因素。方法回顾性分析2020年1月~2023年7月于徐州医科大学附属医院行显微镜下开颅夹闭前交通动脉瘤手术治疗患者的临床资料。采用单因素和多因素Lo-gistic回归分析评价术后发生迟发性脑梗死的影响因素。结果在140例患者中,有13例(9.3%)患者术后出现了迟发性脑梗死。单因素分析结果显示,患者的Hunt-Hess等级评分、改良Fisher分级、术中前交通动脉瘤破裂、动脉瘤形态不规则、术中应用吲哚菁绿荧光造影、术中应用罂粟碱、术中行脑室穿刺引流等差异均有统计学意义(P<0.05)。将单因素分析中差异有统计学意义的因素进行多因素Logistic回归分析,结果显示,改良Fisher分级和术中前交通动脉瘤破裂为发生术后迟发性脑梗死的独立危险因素,而术中应用吲哚菁绿荧光造影为保护性因素(P<0.05)。结论改良Fisher分级和术中前交通动脉瘤破裂被确认为显微镜下行开颅夹闭前交通动脉瘤术后发生迟发性脑梗死的独立危险因素,而术中应用吲哚菁绿荧光造影可以有效降低术后迟发性脑梗死的发生率。 展开更多
关键词 前交通动脉瘤 开颅夹闭手术 术后迟发性脑梗死 影响因素
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颅内动脉瘤破裂伴血肿夹闭术预后模型构建
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作者 郭晓竑 方军康 +3 位作者 陆珍燕 武弋 洪鹏超 方小康 《中国现代医生》 2024年第21期21-25,共5页
目的探究颅内动脉瘤破裂伴血肿患者夹闭术后预后不良的影响因素并构建临床预测模型。方法选取2017年9月至2023年10月东阳市人民医院收治的151例动脉瘤性颅内血肿患者。术后3个月,采用改良Rankin量表(modified Rankin scale,mRS)进行评... 目的探究颅内动脉瘤破裂伴血肿患者夹闭术后预后不良的影响因素并构建临床预测模型。方法选取2017年9月至2023年10月东阳市人民医院收治的151例动脉瘤性颅内血肿患者。术后3个月,采用改良Rankin量表(modified Rankin scale,mRS)进行评分分组,预后良好组93例,预后不良组58例。采用单因素分析和多因素Logistic回归分析探究影响患者术后预后不良的风险因素,构建颅内动脉瘤破裂伴血肿患者夹闭术后预后不良预测模型,采用受试者操作特征曲线下面积(area under the curve,AUC)反映模型的鉴别效度,采取Hosmer-Lemeshow检验建立模型的拟合度。结果Hunt-Hess分级Ⅳ~Ⅴ级(OR=5.339)、改良Fisher分级Ⅲ~Ⅳ级(OR=5.145)、血肿量≥50ml(OR=7.426)、血肿清除率≤50%(OR=8.381)、责任动脉瘤直径>5mm(OR=3.053)、手术时间窗>5h(OR=2.659)、术中血管区操作时间>3h(OR=2.305)为颅内破裂动脉瘤伴血肿患者夹闭术后预后不良的独立风险因素(P<0.05)。本研究构建的夹闭术后预后不良预测模型的AUC为0.863(95%CI:0.781~0.946,P<0.001),模型预测效能较好,特异性79.6%,敏感度86.2%,预测正确率为82.1%。Hosmer-Lemeshow检验χ^(2)=5.778,P=0.679,模型预测值与实际观测值无显著差异。结论Hunt-Hess分级Ⅳ~Ⅴ级、改良Fisher分级Ⅲ~Ⅳ级、血肿量≥50ml、血肿清除率≤50%、责任动脉瘤直径>5mm、手术时间窗>5h、术中血管区操作时间>3h为颅内动脉瘤破裂伴血肿患者夹闭术后预后不良的风险因素。本研究构建的模型预测效能较高,可为临床开颅夹闭术患者治疗及术后康复提供指导。 展开更多
关键词 颅内动脉瘤破裂 血肿 开颅夹闭术 预后 模型构建
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CT灌注成像评估颅内动脉瘤介入与夹闭手术的效果
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作者 陈阳 徐爱民 田成斌 《临床医学工程》 2024年第7期783-784,共2页
目的探讨CT灌注成像评估颅内动脉瘤介入与夹闭手术的效果。方法选择2021年1月至2022年12月我院收治的94例颅内动脉瘤患者,依据手术方式不同分为介入组(52例,颅内动脉瘤介入术)和夹闭组(42例,开颅瘤颈夹闭术)。两组患者均行CT灌注成像检... 目的探讨CT灌注成像评估颅内动脉瘤介入与夹闭手术的效果。方法选择2021年1月至2022年12月我院收治的94例颅内动脉瘤患者,依据手术方式不同分为介入组(52例,颅内动脉瘤介入术)和夹闭组(42例,开颅瘤颈夹闭术)。两组患者均行CT灌注成像检查,比较两组CT灌注参数、并发症发生情况及不同预后患者CT灌注参数。结果术后12 h,介入组脑血容量(CBV)、脑血流量(CBF)均高于夹闭组(P<0.05)。两组平均通过时间(MTT)比较差异无统计学意义(P>0.05)。随访6个月,介入组并发症发生率为7.69%,低于夹闭组的38.10%(P<0.05)。血管痉挛患者CBV、CBF低于非血管痉挛患者,脑梗死患者CBF低于非脑梗死患者(P<0.05)。结论CT灌注成像评估颅内动脉瘤介入与夹闭手术的效果显著,能够预测血管痉挛、脑梗死。 展开更多
关键词 颅内动脉瘤介入 开颅瘤颈夹闭术 CT灌注成像
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神经电生理监测在颅内多发动脉瘤的一期手术中的应用
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作者 梁玉红 张文芳 +3 位作者 陈锋 周毅 彭鹏 胡克琦 《中国临床神经外科杂志》 2024年第1期16-18,共3页
目的探讨神经电生理监测(NPM)技术在颅内多发动脉瘤(MIA)一期手术中的应用价值。方法回顾性分析2018年1月至2022年6月NPM辅助下一期手术治疗的30例MIA的临床资料。术前行颅脑CT平扫、CTA和/或DSA检查确诊,术中动态监测体感诱发电位(SEP... 目的探讨神经电生理监测(NPM)技术在颅内多发动脉瘤(MIA)一期手术中的应用价值。方法回顾性分析2018年1月至2022年6月NPM辅助下一期手术治疗的30例MIA的临床资料。术前行颅脑CT平扫、CTA和/或DSA检查确诊,术中动态监测体感诱发电位(SEP)、运动诱发电位(MEP)、脑干听觉诱发电位(BAEP)和脑电图(EEG)。结果30例共发现69个动脉瘤,其中23例有2个动脉瘤,5例有3个动脉瘤,2例有4个动脉瘤;动脉瘤直径<0.5 cm有11个,0.5~1.5 cm有28个,1.5~2.5 cm有25个,≥2.5 cm有5个。术后复查CTA示69个动脉瘤均完全夹闭,载瘤动脉通畅。25例术中NPM指标正常;5例在临时阻断时指标异常,采取干预措施后,3例监测波形恢复正常,术后肢体功能无异常;2例下肢SEP未恢复至基线水平,术后下肢肌力4级。术后随访3个月,2例术中NPM指标正常者术后存在肢体运动功能障碍,1例左上肢肌力2级、左下肢肌力3级,GOS评分3分;另1例左侧上、下肢肌力均为3级,GOS评分4分;其余28例中,GOS评分3分4例,4分6例,5分18例。结论一期手术治疗MIA时,术中NPM技术对相关缺血事件具有预警作用,及时处理能够避免和降低手术操作导致的神经功能损伤。 展开更多
关键词 颅内多发动脉瘤 神经电生理监测 显微手术 一期手术
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