颅内多发动脉瘤显微外科手术治疗体会

目的探讨显微外科手术治疗颅内多发动脉瘤的安全性和有效性。方法回顾性分析18例颅内多发动脉瘤患者显微外科手术病例的临床资料,通过术前Hunt-Hess分级和术后3～6个月随访格拉斯哥预后量表(GOS)评分进行评价,得出结论。结果 18例颅内多发动脉瘤患者,17例2个动脉瘤,1例3个动脉瘤;动脉瘤分布于一侧+中线部位10例,分布于左右两侧7例,分布于前循环+后循环1例。显微外科手术治疗37个动脉瘤,夹闭37个;手术单侧一切口16例,双侧两切口2例;3～6个月后随访,GOS评分5分14例,4分1例,3分1例,3分以下2例,无死亡病例。以GOS评分4～5分为预后良好标准,预后良好率为83.3%。结论显微外科手术是治疗颅内多发动脉瘤的一个有效安全的治疗手段。入路要个性化选择,对于入路对侧和深部动脉瘤要选择性夹闭,不可强行冒险夹闭。

Experience in microsurgery of multiple intracranial aneurysms

Objective To investigate the safety and effectiveness of microsurgical treatment for multiple intracranial aneurysms(MIA).Methods The clinical data of 18 patients with MIA underwent microsurgery were analyzed retrospectively.The results were evaluated by Hunt-Hess grade before operation and Glasgow outcome scale(GOS)score after 3-6 months of follow-up.Results There were 18 cases of MIA,17 cases of 2 aneurysms and 1 case of 3 aneurysms.Aneurysms were distributed in one side+midline in 10 cases,left and right in 7 cases,and anterior circulation+posterior circulation in 1 case.37 aneurysms were treated by microsurgery and 37 aneurysms were clamped.There were 16 cases of unilateral incision and 2 cases of bilateral incision.After 3-6 months follow-up,GOS score was 5 in 14 cases,4 in 1 case,3 in 1 case,and less than 3 in 2 cases.There was no death.According to GOS score of 4-5,the good prognosis rate was 83.3%.Conclusions Microsurgery is an effective and safe treatment for MIA.The approach should be selected individually.The contralateral and deep located aneurysms of the approach should be selectively clamped,and the clamping should not take risk.