动脉瘤性蛛网膜下腔出血急诊手术治疗分析

目的探讨动脉瘤性蛛网膜下腔出血的诊断、急诊手术治疗以及脑血管痉挛的防治措施。方法回顾性分析33例动脉瘤性蛛网膜下腔出血患者的临床资料。结果术前12例行DSA检查，检出动脉瘤16枚；27例行CTA检查，检出动脉瘤30枚；其中有6例先后行CTA、DSA检查，两者完全符合。全部病例均在早期行显微手术治疗，无术中死亡病例，术后16例恢复良好，9例有轻度神经功能障碍，3例重度神经功能障碍，植物生存1例，死亡4例。结论动脉瘤性蛛网膜下腔出血急诊CTA检查明确病因更具优势；早期手术、预防脑血管痉挛能有效改善患者的预后。

Emergent Microsurgery for Acute Subarachnoid Hemorrhage due to Rupture of Intracranial Aneurysms

Objective To investigate the diagnosis and emergent microneurosurgical treatment of the acute subarachnoid hemorrhage （SAH） due to the rupture of intracranial aneurysm, and the prevention of cerebral vasospasm after SAH. Methods The clinical data of 33 patients with aneurismal SAH, who underwent emergent mierosurgery from January, 20045 to October, 2007, were analyzed retrospectively. Results There were 37 aneurysms in 33 patients with aneurismal SAH according to preoperative DSA and/or CTA. The aneurysms were successfully clipped in 31 patients with 35 intracranial aneurysms and the aneurysms were wrapped in 2 patients within 3 days after SAH. Of 33 patients, 16 were lccovered well, 9 moderately disabled, 3 severe disabled, 1 vegetatively survived and 4 died. Conclusions CTA especially under the emergent circumstance, is superior to the other imaging examinations for diagnosing intracranial aneurysm. Microsurgery early after SAH and active the prevention of cerebral vasospasm were helpful to improving prognosis in the patients with ruptured intracranial aneurysms.