Objective To explore the clinical characteristic and operation strategy of ruptured middle cerebral artery aneurysms (MCAA) with brain hematoma by frontal-temperal approach. Methods 24 patients with ruptured MCAA accompanied with intracerebral hematoma were adopted by preoperative emergent CTA to determine the location and size of aneurysm. The patients were exerted by microneurosurgery via frontal-temperal approach within 6 hours of admittance. All cases received aneurysm occlusion and evacuation of hematoma. 4 hours after the opreation, all cases received CT Scan and 320-CTA examination, to determine hematoma clearance and the patency of the parent artery. Results Confirmed by the reexamination, the intracerebral, hematoma clearance rate was 90％ ～ 100％. All aneurysms were completely clipped and the parent artery was unobstructed and was not be mistaken clipped. All patients were followed up for 6 months. GOS scale at 6 monthesm showed there were 2 patients with 5 scores, 17 with 4 scores and 5 wih 3 scores. Conclusion According to the patients with ruptured cerebral aneurysms accompanied by intracerebral hematoma volume, it would be feasible and effective via extended frontal-temperal approach.%目的 探讨大脑中动脉瘤破裂合并颅内血肿的临床特点及手术治疗策略.方法 24例大脑中动脉瘤破裂伴有脑内血肿患者, 术前急诊行CTA检查确定动脉瘤的位置、大小;均在发病6 h内经扩大额颞入路显微手术治疗, 行动脉瘤夹闭+血肿清除术.术后4 h复查头部CT及CTA, 了解血肿清除情况和载瘤动脉及其分支通畅与否.结果 本组患者术后CT及CTA复查证实, 血肿清除率在90％～100％;所有的动脉瘤均被完全夹闭, 载瘤动脉均通畅, 无误夹血管.术后随访6个月, 术后6个月时的格拉斯哥预后量表 (Glasgow outcome scale, GOS) 评分:5分者2例, 4分者17例, 3分者5例.结论 对于大脑中动脉瘤破裂合并脑内血肿患者的治疗, 采用扩大额颞入路早期手术, 能取得较好的效果.
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