颅内多发动脉瘤的显微手术治疗

目的 总结颅内多发动脉瘤显微手术的经验。方法 回顾性分析8例17个颅内动脉瘤的临床资料。结果 对患者随访半个月-10年,按Sundt的随访结果评定标准评定：5例满意,2例好转,1例死亡（为双侧后交通动脉瘤术后1周）。结论 颅内多发性动脉瘤可尽早一期手术,特别是双侧动脉瘤患者,采用冠状切口双侧翼点入路,先夹闭容易出血侧的动脉瘤,再夹闭另外一侧为宜。此入路具有创伤小、暴露好,省时省力等优点。     

显微手术治疗宽颈颅内动脉瘤

显微手术治疗宽颈颅内动脉瘤孙丕通，赵仰胜宽颈颅内动脉瘤并不少见，但对其发生率及诊断标准尚未见报道。由于这种动脉瘤手术治疗困难，我们回顾性复习１３例经验如下。临床资料从１０８５年１０月至１９９２年９月，我院收治１３例宽颈颅内动脉瘤，其中男３例。年龄３５...     

颅内动脉瘤的显微手术治疗

近２年固余选择性连续显微手术治疗８９例颅内动脉瘤，其中术前Ｈｕｎｔ－Ｈｅｓｓ分级，Ⅰ级２４例，Ⅱ级３８例，Ⅲ级１８例，Ⅳ级６例，Ⅴ级３例。３例在手术室内出血后立即手术治疗，３例在３天内手术，４３例在３～１４天内手术，４０例在出血后１４天以后手术。近期手术死亡率为３．３％。２年内总死亡率为５．６％，重残率为３．４％。临床证明显微手术技术的正确使用是颅内动脉瘤手术成功的关键。     

显微手术治疗颅内动脉瘤

目的 总结报道显微手术治疗颅内动脉瘤的临床效果。方法 回顾分析89例显微外科手术治疗颅内动脉瘤的手术时机、动脉瘤颈的暴露及夹闭技巧。结果 89例显微外科手术，共夹闭动脉瘤95个。术后症状明显好转，剧烈头痛1～5d内消失；有嗜睡表现的19例术后1周内16例完全清醒；对侧肢体瘫痪的41例中，有35例肌力恢复在Ⅳ级以上，其余6例肌力恢复到Ⅱ～Ⅲ级。动眼神经麻痹7例有4例完全恢复，3例眼裂有不同程度增宽。脑膜刺激征阳性的65例有63例1周内转为阴性。按Glasgow预后指标分级：其中1级65例（73。0％）、2级12例（13.5％）、3级6例（6．7％）、4级3例（3.4％）、5级（即死亡）3例（3．4％）。结论 采用显微外科技术治疗颅内动脉瘤，能精确保护穿支动脉，减少术中动脉瘤破裂及术后脑血管痉挛，明显提高颅内动脉瘤手术的临床疗效。     

多发性颅内动脉瘤的治疗

目的 比较显微外科与血管内治疗对多发性颅内动脉瘤（MIA）的治疗效果和并发症发生率的差别。方法 回顾分析20例MIA（共46个动脉瘤）,根据MIA所在部位的区域分级标准,Ⅰ级8例（占40%）,Ⅱ级10例（占50%）,Ⅲ级2（占10%）。级别越高者,多倾向于选择血管内治疗。结果 显微外科手术组8例,共19个动脉瘤,18个镜下全部夹闭、1个没发现未夹闭。血管内治疗组8例,共17个动脉瘤,14个100%闭塞、1个90%以上闭塞、2个因动脉瘤小导管不能到位未治。颅内外血管搭桥加颈内动脉闭塞2例。未治2例。结论 MIA所在部位的区域分级有助于治疗方法的选择,对MIA多倾于血管内治疗,必要时可2种方法联合应用。     

22例颅内多发动脉瘤的手术治疗

为了探讨颅内多发性动脉瘤(MIA)的手术治疗及其效果，我们对2001年1月～2004年4月我院收治的22例颅内MIA进行回顾性分析。     

显微外科与血管内治疗联合处理颅内动脉瘤

随着电解可脱弹簧圈（Ｇｕｇｌｉｅｌｍｉｄｅ－ｔａｃｈａｂｌｅｃｏｉｌｓ,ＧＤＣ）和机械可脱弹簧圈（Ｍａｃｈｎｉｃａｌｄｅｔａｃｈａｂｌｅｃｏｉｌｓｙｓｔｅｍ,ＭＤＳ）的问世,已有文献报道用ＧＤＣ和ＭＤＳ来治疗颅内动脉瘤,完全闭塞率达８０％［１、２］。...     

颅内动脉瘤的显微外科治疗

目的 :总结颅内动脉瘤显微外科治疗经验 ,探讨显微手术技巧。方法 :总结显微外科手术夹闭 2 1例颅内动脉瘤患者的临床资料 ,在气管插管全麻及控制性降压下手术 ,手术采用改良Yasargil入路 ,显微镜下直视操作 ,解剖动脉瘤颈 ,稳妥的夹闭动脉瘤蒂 ,必要时实行瘤体切除及瘤颈加固。结果 :2 1例全部行动脉瘤夹闭术。 2例因瘤体巨大在行瘤颈夹闭后行瘤体切除术。术中动脉瘤破裂 3例 ,死亡 1例。治愈率 95 .2 % ,死亡率 4.7%。结论 :显微外科技术对提高颅内动脉瘤手术成功率至关重要。动脉瘤术中破裂出血是手术失败和致死的重要原因。术中采用有效的控制性降压和临时阻断是处理术中动脉瘤破裂出血的重要应急措施。     

32例颅内动脉瘤显微手术治疗

目的总结颅内动脉瘤中的显微手术经验,提高手术效果。方法回顾显微外科手术夹闭32例动脉瘤的手术时机及术中操作要点。结果显微手术治疗32例动脉瘤,28例痊愈,3例部分偏瘫或语言智能障碍,1例死亡,病死率3.2%。结论显微手术夹闭颅内动脉瘤效果良好。对动脉瘤术前Hunt分级Ⅰ～Ⅱ级者应尽早手术,Ⅲ级及以上者,待病情平稳后再手术。     

颅内动脉瘤——颅内巨大动脉瘤的手术治疗

颅内巨大动脉瘤是指最大外径 >2 5mm动脉瘤 ,其约占颅内动脉瘤的 3 %～ 13 % ,平均 5 %左右。发病年龄与普通动脉瘤无明显差别 ,多见于 40～ 60岁之间。好发部位以眼动脉、颈内动脉分叉部、椎基底动脉、大脑中动脉为多见。巨大动脉瘤往往为宽颈 ,甚至所累及的载瘤动脉也增粗 ,由于瘤体巨大而使正常的血管分支发生移位。动脉瘤内发生粥样硬化斑块、硬血栓以及部分钙化也相当常见。动脉瘤形态亦不规则 ,呈半梭状、梭状或蛇形改变的发生率也相当高。巨大动脉瘤的这些特点也正是造成手术困难的主要原因。巨大动脉瘤的手术治疗应基于病史、患者年…     

颅内镜像动脉瘤的外科治疗

目的 探讨颅内镜像动脉瘤的临床特点和治疗策略.方法 回顾性研究2007年11月至2012年11月治疗的19例20对颅内镜像动脉瘤患者资料.其中男性6例,女性13例,年龄32～75岁,平均56岁.双侧后交通动脉瘤11例(其中1例伴发双侧脉络膜前动脉瘤),双侧大脑中动脉分叉部动脉瘤4例,双侧床突旁动脉瘤3例,双侧胼周-胼缘动脉瘤1例.根据出血部位、Hunt-Hess临床分级、动脉瘤的部位、大小等制定手术策略.结果 一期同时夹闭两侧动脉瘤4例,二期分次夹闭两侧动脉瘤3例,手术夹闭联合介入栓塞动脉瘤2例,只处理一侧动脉瘤10例.出院时格拉斯哥评分(GOS)5分者15例(15/19),4分(轻残)4例(4/19).术后随访3～ 50个月,平均18.6个月.2例术后出现动眼神经麻痹,随访3个月1例恢复,1例未好转.10例对侧动脉瘤未处理者动脉瘤直径均小于5 mm且形态规则,为未破裂动脉瘤.9例一期或二期处理双侧镜像动脉瘤的患者随访时无动脉瘤残颈或复发.结论 颅内镜像动脉瘤是多发动脉瘤的一种特殊类型,应优先处理责任动脉瘤,对侧未破裂动脉瘤可以采取观察、一期同时处理或二期延期处理等策略.     

Surgical treatment of multiple intracranial aneurysms

Summary A retrospective review of 126 patients with multiple aneurysms seen over a 10 year period was undertaken. They had a total of 302 aneurysms. Thirty-seven percent of the patients were males, and 63% were females. Direct operations were performed on 97 cases. Both the ruptured and unruptured aneurysms were treated in 71% (69 of the 97 cases), and only the ruptured aneurysms were treated in 29% (28). In 69 cases in whom both ruptured and unruptured aneurysms were treated, one-stage operations were used for 48 cases, and two-stage operations were used for 21 cases. Thirty-four of the 48 cases, who were treated in one-stage operations, were operated on by day 4 after subarachnoid haemorrhage. In 12 cases, a total of 13 small unruptured aneurysms, which had not been found by preoperative angiograms, were discovered during surgery, and 9 of the 13 were discovered while removing blood clots to reduce cerebral vasospasm. Regardless of the operative method selected and the timing of operations, the surgical outcome of patients with multiple aneurysms was comparable to that of the 228 cases with single aneurysms treated during the same period at the same hospital.The analysis of this study suggests that surgical results for multiple aneurysms are satisfactory, even for early operations. Further, the actual incidence of multiple aneurysms may be higher than has been reported to date because small unruptured aneurysms which have been discovered during clot removal may not have been reported.     

Surgical prognosis of unruptured intracranial arterial aneurysms

Summary The authors analyze a series of 53 patients who presented with unruptured intracranial aneurysms. Fifty were operated upon, 2 died during the post-operative period, 5 were left with their pre-operative neurological deficit, 43 were cured and have not subsequently presented with any cerebral or meningeal haemorrhages. None of the 3 patients who were not operated upon has since presented with a cerebro-vascular accident.Twenty-five aneurysms were asymptomatic, discovered fortuitously during angiographic examination, and their size was generally between 3 and 6 mm. Twenty-eight aneurysms presented with various neurological signs and symptoms (headaches, facial pain on 9 occasions, ischaemic vascular accidents on 7 occasions, ocular signs on 8 occasions and generalized epilepsy on 4 occasions), with a range in size from 7 to 10 mm. The clinical and autopsy series published in the literarure show the usefulness of surgery when certain factors come together and increase the risk of rupture: middle-aged patients (between 40 and 65), arterial hypertension, aneurysm located on the anterior part of the circle of Willis and with a diameter close to the critical size (10 mm) for rupture.     

Surgical outcome for multiple intracranial aneurysms

Summary The surgical outcome of 221 cases with multiple intracranial aneurysms operated upon during the years 1988 to 1994 were reviewed. The patients were classified into three groups according to the locations of the aneurysms; group 1: multiple aneurysms located unilaterally in the anterior circulation only (147 cases); group 2: multiple aneurysms located bilaterally in the anterior circulation only (44 cases) and group 3: multiple aneurysms located in both anterior and posterior circulation or in the posterior circulation alone (30 cases). In 132 cases of group 1 (89.8%) all aneurysms were treated in one-stage operations. Twenty-eight patients from group 2 (63.6%) received partial treatment, where only the ruptured or the symptomatic aneurysms were treated. In 12 other cases from group 2 (27.3%) all multiple aneurysms were treated in two-stage operations. In group 3 patients, one-stage operations were performed in 18 cases (60%), while 9 patients (30%) received partial treatment only. Of the 221 multiple aneurysm cases, 162 (73.3%) presented with manifestations of subarachnoid haemorrhage (SAH). The remaining 59 multiple aneurysms cases (26.7%) presented with manifestations other than SAH (unruptured aneurysms). In the postoperative follow-up, of the 221 multiple aneurysms cases, 113 (51.1%) were free of neurological deficit (excellent), 48 cases (21.7%) were capable of leading an independent life (good), 32 cases (14.5%) were not independent and needed to be assisted (fair), and 28 patients (12.7%) died. These results were comparable to the results of patients with single aneurysms operated on during the same period.Based on our results, we recommend that whenever possible all multiple aneurysms should be treated in one-stage operations. In unruptured multiple aneurysm cases surgical management is the recommended treatment. In poor grade SAH patients or unruptured multiple aneurysms in old patients, two-stage operations or partial treatment of only the ruptured or the symptomatic aneurysms may be adopted.     

Surgical treatment of multiple intracranial aneurysms

Summary Patients with multiple intracranial aneurysms present a great challenge to neurosurgical practice. The presence of one or more additional aneurysms, whether recognized or unrecognized, along with the source of the haemorrhage profoundly changes the outcome. It also alters the timing and strategy of surgery. In this study the experiences gained from 138 cases with a total of 317 aneurysms are discussed. The analysis of the clinical data, our results and the factors influencing the outcome suggest that the risk of clipping all aneurysms simultaneously are less than the risk of a rebleed from an untreated, previously silent sac even in the early postoperative period.     

Surgical experiences with giant intracranial aneurysms

Summary The common method of presentation of intracranial aneurysms is at the time of their rupture (with subarachnoid haemorrhage) or on the occasion of their compression of neighbouring structures. While giant aneurysms may occasionally present with subarachnoid haemorrhage, their more common methods of presentation are due to their space occupying and neighbourhood effects²².Giant aneurysms are commonly defined as those with a diameter larger than 2.5cm. Previously this diameter was assessed either by arteriography, so that size meant internal diameter, or by the displacement of surrounding structures, as for example, small perforating vessels, which could be attributed positively to the presence of a larger mass. Before CT scanning however, the factor of a very considerable larger aneurysm, partly occluded by clot could occasionally cause unexpected operative difficulty. The advent of CT scan and now especially MR imaging has made the prediction of the size of the aneurysm much easier and the extent of the intraaneurysmal clot also clearly definable. This paper describes one surgeon's experience with 64 giant cerebral aneurysms operated on in the last 10 years (Table 1). It has emerged from this experience that the most satisfactory method of handling the lesion is to remove the intra-aneurysmal clot and clip the neck of the aneurysm, and the steps necessary to secure this laudable design form the burden of the paper.Presented at the EANS-Wintermeeting on High Risk Neurosurgery, Budapest, February 20–23, 1991.     

Surgical treatment of unruptured intracranial aneurysms

Summary The author has reviewed a series of 19 patients with unruptured aneurysms treated surgically during a 5-year period from 1976 to 1981. Unruptured aneurysms found in patients with multiple aneurysms and subarachnoid haemorrhage due to ruptured aneurysms are not included in this series. Literature on this subject is reviewed. There was no mortality and results were excellent in 7 patients with asymptomatic aneurysms. In 12 patient with symptomatic aneurysms there was no mortality and results were good to excellent in 9 patients. In 2 the results were unsatisfactory.The series included aneurysms varying in size from 5 mm to over 2.5 cm (giant aneurysm). Controversial aspects of surgery of unruptured intracranial aneurysms are discussed. The authors recommend surgical treatment of unruptured intracranial aneurysms regardless of size until such time when more definitive information is available about the natural history of these lesions.     

Surgical treatment of multiple aneurysms

Summary We review the surgical results in 372 cases of multiple intracranial aneurysms over a 25-year period in which one of us (JS) performed 2,000 direct operations for aneurysms. All patients were classified into four groups according to the location of the aneurysm: Group 1: multiple aneurysms including anterior communicating artery aneurysm (157 cases); Group 2: multiple aneurysms of unilateral anterior circulation (72 cases); Group 3: multiple aneurysms of bilateral anterior circulation (110 cases); Group 4: multiple aneurysms including vertebro-basilar artery aneurysms (33 cases).In multiple aneurysm cases, our policy has been to treat all aneurysms, ruptured and unruptured, in a one-stage operation whenever possible. About 90% of patients in both Group 1 and 2 were treated by one-stage operations, while 60% of patients in Group 3 and 42% of patients in Group 4 were operated on in the same manner.Excellent and good results in from 73% to 81% of cases were obtained in patients in Group 1, Group 2 and Group 3. Morbidity was 14–19% and mortality was 6–8%. These results were comparable to the results with a single aneurysm of the anterior circulation. On the other hand, the surgical results in Group 4 were poor with a mortality of 27%. Poor results were attributable to the postoperative rebleeding from the untreated vertebro-basilar aneurysms, which were thought to be unruptured aneurysms preoperatively.Furthermore, it was clarified that the results of early one-stage operations (within one week from onset) in patients with multiple aneurysms were satisfactory. In this group, there was good recovery in 84% of patients, 7% were disabled and 9% died. The morbidity was notably lower in patients operated on within one week than in those operated on after 8 days. Based on these results, the one-stage operation in the acute period is recommended for patients with multiple aneurysms.     

以蛛网膜下腔出血起病的颅内多发动脉瘤的诊治

【摘要】〓随着脑血管成像技术的广泛应用及不断提高,动脉瘤性蛛网膜下腔出血患者中多发动脉瘤检出率越来越高。研究表明既往有蛛网膜下腔出血病史患者的未破裂动脉瘤破裂风险要高于无蛛网膜下腔出血病史者,对于发生动脉瘤破裂的多发动脉瘤患者除明确责任动脉瘤并首先处理外,其未破裂动脉瘤也应尽量检出并积极治疗,因此多发动脉瘤的诊断和治疗均要比单发动脉瘤复杂。