颅内前循环动脉瘤手术时机与预后探讨

　　【摘要】 目的：探讨颅内前循环动脉瘤破裂出血的手术时机及手术后的疗效及脑血管痉挛的治疗。方法：颅内前循环动脉瘤破裂出血41例中，蛛网膜下腔出血40例，未破裂动脉瘤1例;Hunt-HessⅠ级9例，Ⅱ级16例，Ⅲ级11例，Ⅳ级3例，Ⅴ级2例;行DSA检查29例，行CTA检查8例，行MRA检查4例，手术采用改良的Yasargil入路。结果：41例患者均成功夹闭动脉瘤。出现血管痉挛、脑梗死致偏瘫、失语3例，有精神症状1例，动眼神经麻痹5例。随访3~24个月，恢复良好35例，轻残2例，重残3例，植物生存1例。结论：早期手术可避免动脉瘤再次出血，减轻脑血管痉挛。Hunt Ⅲ级及以下疗效显著，Ⅳ级以上者术后致残率明显增高。

　　【关键词】 颅内前循环动脉瘤;蛛网膜下腔出血;显微手术; 脑血管痉挛

　　Microsurgical treatment of intracranial anterior circulation　aneurysms

　　GU Jianjun，LU Jun，GAO Guangzhong，et al (Department of Neurosurgery，Taizhou People’s Hospital， Taizhou 225300)

　　[Abstract] Objective：41 cases ruptured intracranial anterior circulation aneurysms performed early microsurgery from January 2004 to December 2006 were analysed ret rospectively，probe the optimal technique of microsurgery for early hemorrhage from intracranial aneurysms，treating method for cerebral vasospasm after operation. Methods：Of these 41 cases of intracranial aneurysm，1 case was unruptured intra cranial aneurysms with onset of blepharoptosis.40cases suffered hemorrhage. All patients were classed by Hunt-Hess. All cases were diagnosed by DSA、CTA or MRA.Modified Yasargil’s approach were adopted for all patients. Results：41 cases were completely clipped by aneurysm clips. After clipped，3 cases showed hemiplegia and aphasia because of cerebral vasospasm and cerebral infarction，one case showed psychiatric symptom.5 cases showed oculomotor palsy.In the 3-month to 2-year follow -up，35 cases recovered well，2 cases got in mild disability and 3 cases in severe disability，1 cases in Vegetative state，no death in all the 41 cases. Conclusion：Early surgery clipped can avoid the rebleeding of aneurysm，relieve cerebral vasospasm. Patients below Hunt-Hess grade Ⅲ showed good effects after operation，those above Hunt-Hess grade Ⅳ showed higher disabling rate.

　　[Key words] Intracranial aneurysms;Subarachnoid hemorrhage;Microsurgery;Vasospasm

　　近来颅内动脉瘤的诊断率逐年上升，颅内动脉瘤破裂出血是蛛网膜下腔出血最常见的原因。而颅内动脉瘤破

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