前循环动脉瘤破裂并脑内血肿的显微手术治疗

摘要

Objective To explore microsurgical techniques and curative effects of anterior circulation aneurysms with intracerebral haematoma .Methods 29 patients with ruptured anterior circulation aneurysms with intracerebral hematomas underwent haematoma evacuation and aneurysmal clipping.The clinical features , including the location , size, shape of the aneurysm , the combined intracerebral hematoma size ,shape,preoperative Hunt-Hess grade,GOS in three-month follow-up,were summrized.Results Hunt-Hess gradeⅢwere 10 cases,Ⅳ17 andⅤ2.17 patients with preoperative digital subtraction angiography , 12 three-dimensional CT angiography ( 3D-CTA ) confirmed.The microsurgical outcomes indicated that the intraoperative diagnoses were consistent with preoperative diagnoses in all cases .The ruptured aneurysms include 6 cases of anterior communicating artery aneurysms ,7 posterior communicating artery aneurysms , and 16 middle cerebral artery aneurysms .29 patients with a total of 31 aneurysms were clipped successfully .GOS in three-month follow-up were gradeⅴin 14 cases,grade Ⅳin 7,grade Ⅲin 4,gradeⅡin 2 and gradeⅠin 2.Conclusion For patients with ruptured aneurysms of anterior circlulation combined with intracerebral hematoma , favorable outcome should be achieved through early clipping of the aneurysm , remove the hematoma .%目的：探讨前循环动脉瘤破裂伴脑内血肿手术方法及疗效。方法前循环动脉瘤破裂并脑内血肿患者29例行显微手术治疗，总结其临床特点：动脉瘤部位、大小、形态、合并脑内血肿大小、形态，术前Hunt-Hess分级、手术方式及三个月随访的格拉斯预后评分。结果 Hunt-Hess分级Ⅲ级10例、Ⅳ级17例、Ⅴ级2例。17例患者术前经常规血管造影，12例行三维CT血管造影（3D-CTA）检查证实。29例术中诊断与术前诊断一致，前交通动脉瘤6例，后交通动脉瘤7例，大脑中动脉瘤16例，29例患者共31枚动脉瘤均成功夹闭，3个月后随访时GOS评分Ⅴ级14例，Ⅳ级7例，Ⅲ级4例，Ⅱ级2例，Ⅰ级2例。结论颅内前循环动脉瘤破裂并脑内血肿患者病情危重，早期夹闭动脉瘤，清除血肿，效果良好。