动脉瘤性蛛网膜下腔出血患者再出血的护理

对12例动脉瘤性蛛网膜下腔再出血患者严密观察病情变化，去除诱发因素，加强基础护理及出院指导。结果12例中9例经开颅动脉瘤夹闭或介入弹簧圈栓塞后康复出院，3例Hunt-HessⅣ～Ⅴ级患者因出血量大致脑疝而死亡。提出根据疾病发生的危险因素采取相应的护理措施是降低病死率，提高救治率的关键。     

动脉瘤性蛛网膜下腔出血患者再出血的护理

对12例动脉瘤性蛛网膜下腔再出血患者严密观察病情变化,去除诱发因素,加强基础护理及出院指导.结果12例中9例经开颅动脉瘤夹闭或介入弹簧圈栓塞后康复出院,3例Hunt-Hess Ⅳ～Ⅴ级患者因出血量大致脑疝而死亡.提出根据疾病发生的危险因素采取相应的护理措施是降低病死率,提高救治率的关键.     

动脉瘤性蛛网膜下腔出血患者血清sICAM-1含量变化的动态研究

目的研究动脉瘤性蛛网膜下腔出血（SAH）患者血清可溶性黏附分子-1（sICAM-1）的动态变化规律。方法对30例动脉瘤性蛛网膜下腔出血病人术前、术后1～3d、7～9d、13～15d血清sICAM-1进行动态观察，用TCD检测大脑中动脉血流速度（VMCA）。结果动脉瘤性蛛网膜下腔出血患者血清sICAM-1在术后1～3d、7～9d各均值明显高于对照组，尤以术后7～9d变化最明显；术前、术后有脑血管痉挛组和非脑血管痉挛组差异也有统计学意义。结论动脉瘤性蛛网膜下腔出血患者血清sICAM-1含量与病情演变、脑血管痉挛（CVS）程度有关。     

动脉瘤性蛛网膜下腔出血并发急性脑积水治疗体会

急性脑积水（AHC）是动脉瘤蛛网膜下腔出血3大主要并发症之一。发生率6．8％～30％，是影响病人预后的重要原因。本院收治9例动脉瘤性蛛网膜下腔出血并发急性脑积水，现报道如下。     

动脉瘤性蛛网膜下腔出血后脑血管痉挛的低温治疗

脑血管痉挛(cerebral vasospasm,CVS)是导致动脉瘤性蛛网膜下腔出血(aneurysm subarachnoid hemorrhage,aSAH)患者死亡和残疾的主要原因之一.人们对SAH后CVS进行了广泛的研究,认为红细胞分解产物、血管内皮功能障碍以及分子机制在其发病起关键作用.目前对脑血管痉挛的治疗尚无确切治疗方法,近年来人们尝试应用低温治疗脑血管痉挛,现就SAH后CVS的病理生理机制和低温对于CVS的治疗进展作一综述.     

动脉瘤性蛛网膜下腔出血后脑血管痉挛的低温治疗

脑血管痉挛(cerebral vasospasm,CVS)是导致动脉瘤性蛛网膜下腔出血(aneurysm subarachnoid hemorrhage,aSAH)患者死亡和残疾的主要原因之一.人们对SAH后CVS进行了广泛的研究,认为红细胞分解产物、血管内皮功能障碍以及分子机制在其发病起关键作用.目前对脑血管痉挛的治疗尚无确切治疗方法,近年来人们尝试应用低温治疗脑血管痉挛,现就SAH后CVS的病理生理机制和低温对于CVS的治疗进展作一综述.     

动脉瘤性蛛网膜下腔出血后脑血管痉挛的低温治疗

脑血管痉挛(cerebral vasospasm,CVS)是导致动脉瘤性蛛网膜下腔出血(aneurysm subarachnoid hemorrhage,aSAH)患者死亡和残疾的主要原因之一.人们对SAH后CVS进行了广泛的研究,认为红细胞分解产物、血管内皮功能障碍以及分子机制在其发病起关键作用.目前对脑血管痉挛的治疗尚无确切治疗方法,近年来人们尝试应用低温治疗脑血管痉挛,现就SAH后CVS的病理生理机制和低温对于CVS的治疗进展作一综述.     

动脉瘤性蛛网膜下腔出血后脑血管痉挛的低温治疗

脑血管痉挛(cerebral vasospasm,CVS)是导致动脉瘤性蛛网膜下腔出血(aneurysm subarachnoid hemorrhage,aSAH)患者死亡和残疾的主要原因之一.人们对SAH后CVS进行了广泛的研究,认为红细胞分解产物、血管内皮功能障碍以及分子机制在其发病起关键作用.目前对脑血管痉挛的治疗尚无确切治疗方法,近年来人们尝试应用低温治疗脑血管痉挛,现就SAH后CVS的病理生理机制和低温对于CVS的治疗进展作一综述.     

动脉瘤性蛛网膜下腔出血后脑血管痉挛的低温治疗

脑血管痉挛(cerebral vasospasm,CVS)是导致动脉瘤性蛛网膜下腔出血(aneurysm subarachnoid hemorrhage,aSAH)患者死亡和残疾的主要原因之一.人们对SAH后CVS进行了广泛的研究,认为红细胞分解产物、血管内皮功能障碍以及分子机制在其发病起关键作用.目前对脑血管痉挛的治疗尚无确切治疗方法,近年来人们尝试应用低温治疗脑血管痉挛,现就SAH后CVS的病理生理机制和低温对于CVS的治疗进展作一综述.     

动脉瘤性蛛网膜下腔出血后脑血管痉挛的低温治疗

脑血管痉挛(cerebral vasospasm,CVS)是导致动脉瘤性蛛网膜下腔出血(aneurysm subarachnoid hemorrhage,aSAH)患者死亡和残疾的主要原因之一.人们对SAH后CVS进行了广泛的研究,认为红细胞分解产物、血管内皮功能障碍以及分子机制在其发病起关键作用.目前对脑血管痉挛的治疗尚无确切治疗方法,近年来人们尝试应用低温治疗脑血管痉挛,现就SAH后CVS的病理生理机制和低温对于CVS的治疗进展作一综述.     

Dissecting aneurysms of the anterior cerebral artery and accessory middle cerebral artery. Case report

A 66-year-old woman presented with dissecting aneurysms of the anterior cerebral artery (ACA) and accessory middle cerebral artery (MCA) manifesting as subarachnoid hemorrhage but without radiological evidence of the dissecting aneurysms. Intraoperative observation revealed that the vessel walls were dark purple in color, a typical finding of dissecting aneurysm. The abnormal A1 segment was trapped and the dissecting aneurysm of the accessory MCA was wrapped. In the case of SAH of unknown origin, dissecting aneurysm should always be kept in mind even if the angiogram does not show any abnormal finding. This is the first reported case of dissecting aneurysm of the accessory MCA.     

Ruptured aneurysm at a duplicated middle cerebral artery with accessory middle cerebral artery

Summary. Although many cerebral vascular anomalies are widely recognized, others are less well known or unclassified. Accessory middle cerebral artery (MCA) and duplicated MCA are among uncommon anomalies. We present a very rare case of subarachnoid haemorrhage due to rupture of a saccular aneurysm arising from a duplicated middle cerebral artery which was associated with an accessory middle cerebral artery.     

Characteristics and management of ruptured distal middle cerebral artery aneurysms

Summary Objective. Distal middle cerebral artery (dMCA) aneurysms are very rare with a reported frequency of 2–6%. Typically, patients with ruptured distal MCA aneurysms have poor clinical outcomes because often there is both a subarachnoid haemorrhage (SAH) and an intracerebral haematoma (ICH). The goals of this study were to identify the characteristics of the distal MCA aneurysms and evaluate the optimal treatment for a good outcome. Methods. The clinical, neuroradiological and operative records of 8 patients with a ruptured distal MCA aneurysm who underwent surgical management were reviewed retrospectively. The outcomes were presented according to the Glasgow Outcome Scale (GOS). Results. The clinical characteristics of the patients with ruptured dMCA aneurysms included the following: (1) a fusiform appearance in five out of eight (63%) patients. (2) Mean aneurysm size of 9.4 mm (range 2–35 mm). (3) The location being M2 (insular segment) in three, M2-3 junction in three, and M3 (opercular segment) in two patients. (4) Brain CT images revealed both SAH and an ICH in six of eight (75%) patients with the mean size of the ICH being 10 cc (range 5–25 cc). (5) Re-bleeding occurred in four out of eight (50%) of patients. All patients underwent early surgical treatment and the procedures used for surgical repair were, clipping in five patients, trapping in two, and trapping with end-to-end bypass surgery in one patient. Clinical outcomes were poor in two patients (death) due to severe brain swelling. Conclusions. In this study, dMCA aneurysms had a fusiform shape and a high re-bleeding rate; if ruptured, there was generally ICH and SAH. A good clinical outcome was associated with adequate control of brain swelling and early surgery to prevent re-bleeding.     

The surgery of middle cerebral artery aneurysms

Summary Aneurysms of the middle cerebral bifurcation represent an interesting entity among intracranial saccular aneurysms. Their shape, size, situation, and in particular their relation to the middle cerebral trunk and its branches show wide variations. Topographical analysis of the angiograms offers a great deal of interest in planning surgery.Our experience with 289 patients with middle cerebral artery aneurysms operated on since 1977 are presented. Factors such as number of previous haemorrhages, timing of surgery, preoperative condition, major intraoperative bleeding or brain oedema and delayed postoperative deterioration play a major role in the outcome. Others such as severity of the subarachnoid bleed, age, size of the sac seem to have much less influence.     

Ruptured anterior communicating artery aneurysms associated with fenestration of the anterior cerebral artery

Two patients with ruptured anterior communicating artery aneurysms associated with fenestration of the anterior cerebral artery are reported. In the literature, only 12 angiographic demonstrations of fenestration of the anterior cerebral artery have been reported. All fenestrations were limited to the distal half of the A1 portion, and seven of the 12 cases were associated with aneurysms. The high incidence of coexisting fenestration and aneurysm suggests that congenital factors may play a role in the pathogenesis of cerebral aneurysm.     

Single-stage operation for bilateral middle cerebral artery aneurysms

Summary Background. Subarachnoid haemorrhage with bilateral middle cerebral artery aneurysms is occasionally encountered in neurosurgical practice. We report upon our experiences of the single-stage operation for bilateral middle cerebral artery aneurysms (BMCA) through a bilateral subfrontal approach.Methods. During the past two and half years, we have experienced three cases of BMCAA, who were treated by this method. The whole procedure was conducted using a single-stage head positioning and draping. Slight table tilting was enough to allow the proper clipping of each aneurysm.Findings. During the past 2.5 years, 255 cases of intracranial aneurysm have been treated in our hospital. Among these, the incidence of BMCAA was 1.18% (3/255). The mean duration of operation for the three cases involved was 5.8 hours, and showed a progressive decrease with experience. All patients recovered well, and were discharged as in other uneventful aneurysm cases. The total operation time was longer, and was a little more laborious than normal single aneurysm surgery.Conclusion. This method has substantial advantages over classical skull base approaches to MCA aneurysms. As extensive frontal lobe manipulation and external facial incisions are avoided with subfrontal approaches, intensive care unit and overall hospital stay are reduced, related complications are minimized, and postoperative cosmetic appearance is enhanced.     

The variations of lenticulostriate arteries in the middle cerebral artery aneurysms

Summary This study attempts to analyse the intra-operative anatomical findings of the lenticulostriate artery (LSA) in 60 patients with middle cerebral artery (MCA) aneurysms who were operated on at the Neurosurgical Department of Atatürk University Medical School, Erzurum, Türkiye.All patients underwent radical surgery for aneurysm by the right or left pterional approach. The findings were recorded during surgical intervention using slides and videotapes of the operations. On average there were 4 (range, 1–14, total number=240) LSAs, in one hemisphere, per case with MCA aneurysm. Twenty percent of LSAs (n=48) arise from the prebifurcation part of the M₁ segment, 65% (n=156) arise from the postbifurcation part of the M₁ segment, and 15% (n=36) arise from the proximal part of the M₂ segment. The great majority of the LSAs (85%, n=204) orginated along the proximal part of the MCA. Of a total of 240 LSAs, 125 (52%) originated from one single large vessel, a stem artery which then divided after 2–10 mm into many branches, 85 (35%) originated as two large proximal trunks, and 30 (13%) originated as multiple small arteries arising along the whole infero-medial wall of the M₁ segment of MCA.We concluded that recognition of the anatomical variations of the LSA and detailed knowledge of the microvascular relationships of the MCA aneurysms, will allow neurosurgeons to construct a better and safer microdissection plan, to save time, and to prevent postoperative neurological deficits.     

支架辅助弹簧圈栓塞治疗大脑中动脉分叉部宽颈动脉瘤

目的 观察支架辅助弹簧圈栓塞治疗大脑中动脉分叉部宽颈动脉瘤的安全性和有效性。方法 分析60例接受支架辅助弹簧圈栓塞治疗的大脑中动脉分叉部宽颈动脉瘤患者共65个动脉瘤,观察术后即刻及随访动脉瘤栓塞程度,评估术后并发症、疗效及安全性。结果 术中2例(2/60,3.33%)动脉瘤破裂出血,4例(4/60,6.67%)支架内血栓形成;术后即刻栓塞程度为RaymondⅠ级50个(50/65,76.92%)、Ⅱ级12个(12/65,18.46%)、Ⅲ级3个(3/65,4.62%)。术后1个月内3例(3/60,5.00%)动脉瘤再出血,2例致死;1例(1/60,1.67%)死于肺栓塞;4例(4/60,6.67%)并发脑梗死。1例术后6个月瘤颈复发,1例术后25个月出现无症状性血管闭塞;末次复查数字减影血管造影显示43个(43/51,84.31%)RaymondⅠ级、8个(8/51,15.69%)Ⅱ级。末次随访,49例(49/57,85.96%)改良Rankin量表评分为0～2分,8例(8/57,14.04%)为3～4分。结论 支架辅助弹簧圈栓塞技术治疗大脑中动脉宽颈动脉瘤安全、有效。     

Aneurysm in the penetrating artery of the distal middle cerebral artery presenting as intracerebral haemorrhage

Summary We are recording the first reported case of a 20-year-old man with an intracerebral haemorrhage due to a ruptured aneurysm, which arose from a penetrating artery of the distal middle cerebral artery (MCA; M₄ segment). Excision of the aneurysm was successfully achieved via a right pterional approach. The follow-up angiogram demonstrated filling of the parent vessel and no residual aneurysm. This report illustrates the angiographical finding of a penetrating artery aneurysm of the distal MCA and summarizes the previous reports to discuss their pathological and clinical characteristics.     

Ruptured vertebrobasilar junction aneurysm associated with basilar artery fenestration

Summary A case of a ruptured saccular aneurysm arising from the proximal portion of a partially duplicated basilar artery in a 36-year-old woman is reported. CT and lumbar puncture confirmed subarachnoid haemorrhage. Cerebral angiography detected a vertebrobasilar junction aneurysm associated with basilar artery fenestration. The patient underwent successful clipping and coating of the aneurysm by a right lateral suboccipital osteoclastic approach. Embryological development, pathogenesis, diagnostic and therapeutic difficulties of this vascular malformation are discussed in this report.