老年破裂前循环脑动脉瘤手术策略探讨

目的 探讨预防老年破裂颅内动脉瘤术后脑血管痉挛的显微手术策略.方法 回顾性分析规范手术技巧早期治疗57例60岁以上的颅内动脉瘤病人的临床资料.结果 术后有症状血管痉挛8例,其中后交通动脉瘤术后6例,迟发性血管痉挛性脑梗死死亡1例;脑积水行脑室-腹腔分流术3例.患者出院时按GOS评分,术后恢复良好46例,轻残8例,重残2例,死亡1例.结论 手术夹闭是治疗动脉瘤确实有效的方法,早期手术及规范手术技巧可提高手术效果,降低术后脑血管痉挛及致残率.

Surgical Strategy for Elderly Ruptured Cerebral Anterior Circulating Aneurysm

Objective To explore the strategy of microsurgery for preventing the postsurgical cerebral vasospasm of the elderly ruptured intracranial aneurysms. Methods The clinical data of fifty seven elderly patients（≥60 years old） with in- tracranial aneurysms who underwent early standardized surgical treatment were retrospectively analyzed. Results The postsur- gical review showed that 8 patients had symptomatic vasospasm （6 posterior communicating artery aneurysms）, 1 patient was dead for delayed vasospasm leading to cerebral infarction 3 had hydocephalus and ventriculo-peritoneal shunt was performed. According to Glasgow Outcome Scale （GOS） when left hospital, forty six patients（80.7% ） got good recovery, accompanied by 8 having mild disabilities, 2 severe disabilities and 1 death. Conclusion Surgical clipping is a reliable and effective treatment for aneurysms. Early surgery and standardized surgical skills can improve the surgical efficacy and reduce the postsurgical cerebralvasospasm and the rate of disability.