前交通动脉瘤破裂急性期的综合治疗

目的探讨前交通动脉瘤破裂急性期的综合治疗及手术技巧。方法回顾性分析2002年10月至2009年5月收治的39例破裂前交通动脉瘤患者的临床资料。34例术前经DSA检查确诊为前交通动脉瘤,其中26例行动脉瘤栓塞术,8例行经翼点入路前交通动脉瘤夹闭术。5例危重患者急诊行血肿清除及动脉瘤夹闭术。术后应用高血压、高血容量和高血液稀释疗法及钙离子通道阻滞剂等综合治疗。结果根据GOS评分评定预后,Ⅴ分27例(69.2%,27/39),Ⅳ分5例(12.8%,5/39),Ⅲ分4例(10.3%,4/39),Ⅰ分3例(7.7%,3/39)。术后CT复查示7例存在不同程度的脑缺血灶。术后脑积水1例,行脑室-腹腔分流术。结论前交通动脉瘤破裂出血经DSA确诊后应及早行开颅手术夹闭或血管内栓塞术,对于破裂形成脑内血肿的重症患者应急诊清除血肿并探查夹闭动脉瘤,高血压、高血容量和高血液稀释疗法及钙离子通道阻滞剂等综合治疗措施有利于改善患者的预后。

Comprehensive treatment of acute ruptured aneurysms of anterior communicating arteries

Objective To explore the effect of comprehensive treatment on the acute ruptured aneurysms of anteriorcommunicating arteries （ACA）. Methods The clinical data of 39 patients with ruptured ACA aneurysms, who were treated in our hospitalfrom October, 2002 to May, 2009, were analyzed retrospectively. Of 34 patients with ACA aneurysm were diagnosed by DSA, 26 weretreated by endovascular embolization, and 8 by microsurgery through pterion approach for clipping the ACA aneurysms. The hematomaswere evacuated and the intracranial aneurysms were clipped by emergent craniotomy in 5 patients, in whom DSA was not performed dueto their critical conditions. All the patients were treated by calcium ionic channel blocker and 3H （hypertension, high blood volume andhigh blood dilution） therapy after the operation. Results According to Glasgow Outcome Scale （GOS）, of 39 patients, 27 patientsbelonged in GOS gradeⅤ （69.2%）, 5 in gradeⅣ （12.8%）, 4 in gradeⅢ （10.3%）, and 3 in gradeⅠ （7.7%）. The postoperative CTexamination showed that there was focal cerebral ischemia in different degree in 7 patients. The postoperative hydrocephalus, which wastreated by ventriculoperitoneal shunt, occurred in 1 patient. Conclusions The craniotomy for clipping ACA aneurysms and endovascularembolization should be performed as early as possible in the patients with ruptured aneurysms of ACA diagnosed as by DSA. Thepatients with critical condition due to intracerebral hematomas should be treated by emergeng craniotomy for evacuation of hematomasand clipping the aneurysm. The postoperative treatment including 3H therapy, calcium ionic channel blocker and so on is helpful toimprovement of the prognosis in the patients with ruptured ACA aneurysms.