Hunt-HessⅣ、Ⅴ级颅内动脉瘤手术治疗的分析

目的总结Hunt-HessⅣ、Ⅴ级颅内动脉瘤手术治疗的经验。方法2000年1月至2012年2月手术治疗216例Hunt-HessⅣ、Ⅴ级颅内动脉瘤,其中Ⅳ级192例,Ⅴ级24例。手术夹闭动脉瘤,同时清除颅内血肿,并酌情行去骨瓣减压术。结果术后6个月按GOS评分,Hunt-HessⅣ级192例患者中,预后良好38例,轻残56例,重残60例,植物生存15例,死亡23例;死亡率12.0%。Hunt-HessⅤ级24例患者中,重残5例,植物生存4例,死亡15例;死亡率62.5%。结论对于合并颅内血肿的Hunt-HessⅣ级动脉瘤患者应积极手术治疗。Hunt-HessⅤ级患者手术疗效极差,应该待临床症状稳定后再行治疗。

Clinical effectiveness of microsurgery for poor-grade intracranial aneurysms

ObjectiveTo explore the clinical effectiveness of microsurgery for poor-grade（Hunt-Hess gradeⅣandⅤ） intracranial aneurysms.MethodsTwo hundred and sixteen patients with poor-grade intracranial aneurysm, of whom, 211 patients through extended pterion approach and 5 through semi-coronal approach, received microsurgical clipping from January 2000 to February 2012. The outcomes were assessed according to GOS score 6 months after operation.ResultsOf 192 patients with ruptured aneurysm of Hunt-Hess gradeⅣ, 38 patients recovered well, 56 patients were moderately disabled and 60 severely disabled, 15 vegetatively survived and 23 died. Of 24 patients with ruptured aneurysm of Hunt-Hess gradeⅤ, 5 were severely disabled, 4 vegetatively survived and 15 died.ConclusionsThe progressive treatment should be performed in patients with ruptured aneurysm of Hunt-Hess gradeⅣeven associated with intracranial hematoma. The microsurgery should be delayed in patients with ruptured aneurysm of Hunt-Hess gradeⅤuntil the condition of patients is fair because their outcomes are very poor.