Unruptured cerebral aneurysms causing seizure disorder (report of two cases).

Seizures as a presenting feature of unruptured cerebral aneurysm are unusual. We report two cases of unruptured cerebral aneurysm presented with seizures. In both cases the seizures controlled following surgical ablation of the aneurysm.     

颅内未破裂动脉瘤及其治疗策略

颅内未破裂动脉瘤在临床上比较常见,动脉瘤破裂的后果严重,因此未破裂动脉瘤的研究一直是神经外科的研究热点.颅内未破裂动脉瘤的破裂率与既往蛛网膜下腔出血史、性别与年龄、动脉瘤大小、所处位置、多发动脉瘤、家族动脉瘤史等相关,治疗颅内未破裂动脉的手段主要有开颅夹闭术、血管内介入动脉瘤栓塞术、保守治疗以及动脉瘤孤立术或载瘤动脉闭塞术＋血管吻合术,医师应该根据患者的情况（年龄、并发症等）,动脉瘤情况（大小、形态、位置）以选择合适的方法.现对颅内未破裂动脉瘤的危险因素和治疗方法进行综述.     

大脑中动脉动脉瘤的影像学分型及对夹闭动脉瘤的指导价值

目的 术前根据大脑中动脉动脉瘤(MCAAs)的影像学特点进行分型并探讨其对术中夹闭的指导价值.方法 134例共发现168个动脉瘤,其中MCAAs 143个,术前按瘤顶指向分为4型:指向颞侧58个;额侧29个;侧裂后上方52个;侧裂后下方4个.除2例微动脉瘤肌肉包裹外,141个成功夹闭.结果 根据GOS评分,治愈(5分)111例占82.8％;自理(4分)14例占10.5％;重残或植物生存(3～2分)4例占3.0％;死亡(1分)5例占3.7％.结论 术前影像学分型,术中采用个体化手术技巧分离和夹闭动脉瘤,可减少脑血管痉挛的发生率,提高手术疗效.     

血管内治疗后循环动脉瘤（附24例分析）

目的总结后循环动脉瘤的血管内治疗经验。方法回顾性分析采用血管内栓塞治疗24例后循环动脉瘤的临床资料。入院时Hunt-Hess分级：0级3例,Ⅰ级8例,Ⅱ级6例,Ⅲ级5例,Ⅳ级2例。支架辅助弹簧圈栓塞4例,单纯弹簧圈栓塞20例。结果动脉瘤达致密栓塞（99%～100%）13例,大部分栓塞（90%～98%）8例,部分栓塞（〈90%）3例。随访6～22个月,平均9.2个月;GOS5分16例,4分5例,3分2例,2分1例,无再出血发生。结论血管内栓塞是后循环动脉瘤安全而有效的治疗方法。     

Unruptured intracranial aneurysms: natural history and clinical management. Update on the international study of unruptured intracranial aneurysms

In guiding treatment decisions for all patients with unruptured intracranial aneurysms, it is important to compare size-, site-, and group-specific natural history data with size-, site- and age-specific treatment morbidity and mortality data. Because patient age has a major effect on operative morbidity and mortality, but relatively little effect on natural history, surgical treatment of an UIA patient over age 50 and any treatment of UIA patients over age 70 should be considered with particular vigilance. Optimally, patients should be evaluated and treated at high-volume centers in a setting that emphasizes neurovascular teamwork and unbiased presentation and delivery of different therapeutic option, including the option of observation, which is often appropriate for patients with UIAs.     

脑实质出血123例临床分析

我们采用单纯内科保守治疗或保守治疗加锥颅穿刺血肿抽吸术治疗实质出血共１２３例,６６例行锥颅术,５７例保守治疗,前者存活４６例,死亡２０例;后者存活２２例,死亡３５例。对照结果显示：锥颅穿刺术可明显降低病死率,改善神经功能,且手术简易,损伤小,有很好的推广价值。     

Unruptured intracranial aneurysms in patients with transient cerebral ischemic episodes. Optional managements and literature review

Clinical experience about the management of patients with an unruptured intracranial aneurysm (UIA) presenting transient cerebral ischemic attacks (TIAs) is usually restricted to a few case reports. Some authors assume tha it is safe to perform an endarterectomy without acutely increasing the risk of aneurysm rupture while others reported a post-operative aneurysmal bleeding even for aneurysms smaller than 10 mm between some days and several months after endarterectomy. The aim of this paper is to analyse the factors involved in the particular ischemic episodes, the examination methods to be employed, and the optional management for each individual case on a literature review and own experience-based data.     

大脑中动脉动脉瘤破裂致蛛网膜下腔出血的新CT分型及其临床价值(附121例报告)

目的探讨大脑中动脉动脉瘤(MCAA)破裂后蛛网膜下腔出血(SAH)的CT分型方法及其临床价值。方法 1997年12月至2011年9月开颅夹闭破裂MCAA 121例。依据其SAH CT的特点分为两型,Ⅰ型为脑池出血型,70例;Ⅱ型为脑池出血伴脑实质或脑室出血型,51例。分析这种分型与术前Hunt-Hess分级及患者预后的关系。结果出院时按GOS评估预后,CT分型为Ⅰ型的70例患者中,治愈65例(92.9%),生活自理3例(4.3%),死亡2例(2.9%);51例Ⅱ型患者中,治愈36例(70.6%),生活自理9例(17.6%),重残4例(7.8%),死亡2例(3.3%);两者治愈率差异显著(P<0.01)。CT分型Ⅰ型患者中术前Hunt-Hess分级Ⅰ~Ⅲ级比例(97.1%,68/70)明显高于CT分型Ⅱ型患者(54.1%,28/51;P<0.01)。结论 MCAA破裂后SAH的CT分型与术前Hunt-Hess分级呈正相关,与病人的预后呈负相关。     

Unruptured intracranial aneurysms in patients with transient cerebral ischemic episodes. Optional managements and literature review

Abstract

Clinical experience about the management of patients with an unruptured intracranial aneurysm (UIA) presenting transient cerebral ischemic attacks (TIAs) is usually restricted to a few case reports. Some authors assume that it is safe to perform an endarterectomy without acutely increasing the risk of aneurysm rupture while others reported a post-operative aneurysmal bleeding even for aneurysms smaller than 10 mm between some days and several months after endarterectomy. The aim of this paper is to analyse the factors involved in the particular ischemic episodes, the examination methods to be employed, and the optional management for each individual case on a literature review and own experience-based data.     

大脑中动脉动脉瘤伴脑内血肿的显微手术治疗(附15例分析)

目的探讨显微外科手术处理大脑中动脉动脉瘤伴脑内血肿的临床经验。方法回顾性分析显微手术治疗15例大脑中动脉动脉瘤破裂伴脑内血肿的手术经验。结果均行显微外科手术,在清除血肿的同时夹闭动脉瘤。术后因严重脑梗死导致死亡2例;发生血管严重痉挛2例。对13例随访6～12个月,预后优良9例,中残2例,重残1例,植物状态1例。结论大脑中动脉动脉瘤破裂伴血肿者,致残率和病死率高;充分的术前评估、合适的手术时机和良好的显微外科手术技巧是提高疗效的关键。手术中应尽量避免对大脑中动脉分支血管的损伤,减少术后脑梗死的发生。     

支架辅助栓塞脑宽颈动脉瘤的临床随访研究

目的 总结和评估本组使用支架辅助弹簧圈栓塞脑宽颈动脉瘤患者的临床结果和血管造影结果.方法 2009年4月至2011年10月,共有169例宽颈动脉瘤患者应用Enterprise支架辅助弹簧圈栓塞.利用统计方法评价分析栓塞程度、临床结果、血管造影结果及栓塞相关并发症等.结果 169例患者中,共有166(98.2％)例患者(179枚宽颈动脉瘤)支架释放满意.术中即时造影显示101枚动脉瘤(56.4％)完全栓塞,55枚动脉瘤(30.7％)近全栓塞.接受血管造影随访患者共108例,平均随访时间8.1个月,造影显示95枚动脉瘤(79.8％)为完全栓塞,12枚动脉瘤(10.1％)为近全栓塞.166例患者中6例发生血栓(其中症状性血栓形成5例,无症状性血栓形成1例),术中动脉瘤破裂出血死亡1例.造影随访108例患者中共有10例患者(10枚动脉瘤)复发,均行二期栓塞,栓塞结果满意.结论 Enterprise支架对宽颈动脉瘤的辅助栓塞具有较好的安全性和有效性,完全栓塞率较高以及并发症率较低.     

显微手术治疗破裂前交通动脉瘤35例临床分析

目的 探讨显微外科手术治疗前交通动脉瘤的手术方法及疗效.方法 回顾性分析桂林医学院附属医院神经外科白2008年1月至2011年1月经翼点入路显微手术治疗的35例破裂前交通动脉瘤患者的临床资料,总结手术技巧及疗效. 结果 本组动脉瘤均成功夹闭.随访时间3～6个月,术后死亡2例,轻度残疾3例(1例遗留精神症状),恢复良好11例,完全康复19例.结论 翼点入路手术治疗前交通动脉瘤暴露充分、并发症少;夹闭动脉瘤前充分分离、清晰暴露“H”形的前交通动脉复合体是手术成功的关键;合理的选择动脉瘤夹及血管穿通支的保护尤其重要.     

桥小脑角巨大肿瘤80例临床分析

目的　为桥小脑角巨大肿瘤提供临床鉴别和手术治疗依据。方法　回顾分析８０ 例桥小脑角巨大肿瘤资料。结果　８０ 例肿瘤中,听神经瘤４６ 例（５７５ ％ ） ,脑膜瘤１５ 例（１８８ ％ ） ,上皮样囊肿６ 例（７５ ％ ） ,三叉神经瘤５ 例（６３ ％ ） 及其它少见肿瘤８ 例（１０ ％ ） 。平均年龄４４６ 岁,平均病程４３６ 年。临床表现以一侧听力下降（７０ ％ ） 、共济失调（５８８ ％ ） 及头痛（５３５ ％ ） 为主。后组颅神经损害的发生率（２６３ ％ ） 明显增高。 Ｍ Ｒ Ｉ确诊率达９０９ ％ 。枕下入路手术６８ 例,幕上下联合入路手术１２ 例。肿瘤全切除率５３８ ％ ,面神经保留率８１３ ％ ,手术死亡率８８ ％ ,术后症状改善３６ 例,维持原状３５ 例。随访４２ 例,平均随访期２８ 年。生活自理者３８ 例,复发３ 例。结论　桥小脑角巨大肿瘤种类多样。临床鉴别主要依靠影像学检查。手术疗效令人满意。     

大面积脑梗死68例临床分析

目的探讨大面积脑梗死常见危险因素与治疗。方法对68例大面积脑梗死患者的临床资料进行回顾性分析。结果 68例大面积脑梗死患者存活43例,死亡25例,存活患者中有5例呈植物状态。结论大面积脑梗死是一种病死率和致残率很高的疾病,高血压、糖尿病、高脂血症及房颤均是导致本病的主要危险因素及早诊断与治疗至关重要。     

Anterior cerebral artery occlusion clinical analysis of 27 self-experienced cases

From the years 1977 through 1989, the author experienced 27 cases with only anterior cerebral artery (ACA) occlusion but without any other main cerebral arterial occlusions. These were proven by cerebral angiographies and verified by CT. Two patients showing large infarction in the left frontal lobe on CT but showing no evidence of arterial occlusion by cerebral angiography were also registered in this study because these patients were thought to have recanalized ACA. There were 15 males and 12 females with an age of 61.5 +/- 7.98 (mean +/- SD) and 66.1 +/- 6.45, respectively. Twenty two cases had cerebral thrombosis and 5 had cerebral embolism. There were 4 cases with bilateral ACA occlusions, 8 with right ACA occlusion and 15 with left ACA occlusion. Twenty two patients (81%) were alert on admission and this fact might explain their excellent ADL on discharge: full recovery in 9 patients (33%) and self-management in 12 patients (44%). Seventeen patients (63%) had a CT-proven infarcted area with a correlation to ACA occlusion (s), while 9 patients (33%) showed no correlation between an infarction on CT and an ACA occlusion. One patient showed no abnormal findings on CT. Four patients with right ACA occlusion were incidentally observed, even though their mode of onset was strokes. The symptoms of the other 23 patients were those of anterior cerebral artery syndromes: hemiparesis (74%), urinary incontinence (39%), forced grasping (39%), mutism (30%), indifference (26%) and apraxia (22%) etc.     

前交通动脉瘤的临床分型和显微手术治疗策略

目的通过研究前交通动脉瘤的临床分型与手术难度和预后的关系，探讨前交通动脉瘤的显微手术治疗策略。方法将68例前交通动脉瘤分为视交叉型和纵裂型。对于视交叉型，在抬起额叶前先预先阻断载瘤动脉，然后分离动脉瘤将其夹闭；对于纵裂型，将载瘤动脉临时阻断后，采用瘤体翻转技术将瘤颈显露清楚后将其夹闭。结果瘤颈成功夹闭68例。在术中共有54例（79％）发生了动脉瘤破裂出血。视交叉型组的恢复良好率为95％（22／23），纵裂型的恢复良好率为89％（40／48）。结论视交叉型前交通动脉瘤容易早期破裂，但是分离和夹闭比较容易；纵裂型前交通动脉瘤不易早期破裂，但分离和夹闭比较困难。     

Cllnical analysis on 80 cases with hypertensive cerebral hemorrhage compllcating upper digestive tract hemorrhage

Objective: To irrvestigate the treatment and prognosis of the hypertensive cerebral hemorrhage (HCH)With upper dgest tract hemorrhage (UDDIH). Scence:I a surey of 760 cases randomely with HCH in nerve department betweem Jaruarry 1995 and October 1999, including 80 cases wuth UDTH (9.5%). Of the 80 cases 55 were males and25 were fenales, mean age of 60.2 years andrange of 45 to 80 years. Methods:To analyze the clinical materials of 80 cases with HCH complicating UDTH and HCH without UDTH for the same time. Results: Of the 80 cases 52 were cled during the treatment, death rate was 65%, but the death rate of cases without UDTH was 30.2% at the sane time. The death rate of HCH complicating UDTH was significantly ligher than that without UDTH Discussion The nosogeny of HCH complicating UDTH was more likely related to thalanic and brain-stem Lew is thought that thalemric and brain-stem were stimulated to secret CRF and made pituitany gland release ACTH, futhet secret advencortirn These factors gave rise to UDTH by incriesed to secretion of gastic acid Therefore, original ciseases wre Primarily be predcted and treated Patients with intracranial lypenrtension should be inmediately treated by using manniol or glyceric co, and antiacid, anticholinergic drugs. If all kinds of methods shouldn′t control UDTH, thrombin and noradrenaline bitarlrate with cold Natrii Chlori de would be giwn by nostril There have bettertherapeutic efficiency. Conclusion: HCH with UDTH belongs to severe cases, death rates are higher, original diseases and complication should be actively treated     

Animal model Of cerebral aneurysms: Pathology and pathogenesis of induced cerebral aneurysms in rats

Saccular cerebral aneurysms are induced in rats treated with ligation of one or both of the common carotid arteries, experimental hypertension, and β-aminopropionitrile feeding. Combination of ligation of the carotid artery and experimental hypertension is the minimal requirement for inducing aneurysms within a few months. β-aminopropionitrile makes the arterial wall fragile, increasing the incidence of aneurysmal development. Induced aneurysms are strongly related to haemodynamic stresses. They ere located on the large arteries at the base of the brain. Some of them apparently originate from the apex of bifurcation. The macroscopic and microscopic findings are generally in accordance with those of spontaneous lesions in man. The results of electron microscope and histochemical studies indicate the participation of leukocytes and their lysosomal enzymes in the development and growth of aneurysms. Adventitial cells are also suggested to be responsible for the growth of aneurysms.     

Unruptured aneurysms in patients with transient ischemic attack or reversible ischemic neurological deficit. Report of eight cases

Thirty-five patients with unruptured aneurysms were treated between 1981 and 1987. Eight of them had either transient ischemic attacks or reversible ischemic neurological deficits as their presenting symptoms. Six of the eight patients underwent direct aneurysm surgery. All eight patients are well, and have had no recurrent attack during the follow-up period ranging from 2 to 7 years. The feasibility of surgical treatment for such aneurysms associated with reversible ischemic symptoms is discussed.