超早期显微手术治疗Hunt-Hess Ⅳ、Ⅴ级大脑中动脉动脉瘤

目的探讨超早期（发病12 h内）显微手术治疗Hunt-Hess分级Ⅳ、Ⅴ级大脑中动脉动脉瘤的效果。方法回顾性分析20例入院时Hunt-Hess分级Ⅳ、Ⅴ级大脑中动脉动脉瘤患者的临床资料,均在超早期行显微手术治疗。结果20例动脉瘤均成功手术夹闭。术后随访4-12个月,按照GOS分级,预后良好13例,中残3例,重残2例,植物生存1例,死亡1例。结论对于Hunt-Hess分级Ⅳ、Ⅴ级大脑中动脉动脉瘤患者进行超早期显微手术治疗,能够取得良好的预后。

Ultra-early microsurgery for Hunt-Hess grade Ⅳ-Ⅴ middle cerebral artery aneurysms

ObjectiveTo analyze the effectiveness of ultra-early microsurgery for patients with Hunt-Hess gradeⅣ-Ⅴmiddle cerebral artery（MCA）aneurysms.MethodsTwenty patients with Hunt-Hess gradeⅣ-ⅤMCA aneurysm received ultra-early（2-12hours after bleeding）microsurgery through extended pterional approach from October 2011 to October 2012.The mean follow-up time was 6.5 months（range,4 to 12 months）.The outcomes were evaluated by Glasgow outcome scale（GOS）score at the last follow-up.ResultsThe CT angiography obtained 3-7 days after operation showed that 19 patients were successfully clipped and 1 had residual neck.Two patients received re-operation due to severe cerebral edema.Symptomatic cerebral vasospasm occurred in 11 patients after operation,of whom,9 improved,1 worsened and 1 died after treatment.Pulmonary infection,electrolyte disturbances,gastrointestinal bleeding occurred in 3,6 and 3 patients after operation,respectively;the complications improved after conservative treatment.According to GOS score at the last follow-up,13 patients recovered well,3 were moderately disabled,2 were severely disabled,1 vegetatively survived and 1 died.ConclusionsUltra-early microsurgery can achieve good prognosis in patients with Hunt-Hess gradeⅣ-ⅤMCA aneurysms.The postoperative cerebral edema and cerebral vasospasm are two main factors affecting prognosis for patients with Hunt-Hess gradeⅣ-ⅤMCA aneurysms.