颅内动脉瘤外科治疗的疗效分析

目的 探讨颅内动脉瘤的手术治疗原则和治疗方法 .方法 回顾性总结分析2009年1月至12月139例颅内动脉瘤的治疗效果.其中80例行开颅手术治疗,59例行介入治疗.开颅手术采用动脉瘤夹闭、孤立及包裹等方法 ;介入治疗采用动脉瘤单纯栓塞、支架辅助栓塞等方法 .开颅手术中常规使用脑电图及体感诱发电位进行监测.术中应用多普勒超声和荧光血管造影监测血流情况.结果 80例开颅手术中动脉瘤夹闭73例,颈内动脉阻断动脉瘤孤立6例,动脉瘤包裹1例.59例介入治疗中单纯栓塞33例,支架辅助栓塞26例.80例开颅手术治疗患者中,出院时格拉斯哥预后评分(GOS)5～4分者71例(88.8%),3分者6例(7.5%),2分者1例(1.2%),1分者2例(2.5%).59例介入治疗患者GOS评分5～4分者54例(91.5%),3分者5例(8.5%).结论 开颅手术和介入治疗是颅内动脉瘤的主要治疗方法 ,应当根据患者的实际情况,采取个性化的治疗策略,使患者得到安全、有效、持久的治疗.

The analysis of intracranial aneurysms undergoing surgical treatment

Objective To study the surgical principles and treatment options of intracranial aneurysms. Methods One hundred and thirty nine patients with intracranial aneurysms were retrospectively studied,including 80 open-surgery cases and 59 endovascular-treated cases from January to December in 2009. Open surgical methods included clipping, trapping or wrapping and interventional methods included simple coiling or stent-assisted coiling. Intra-operative electroencephalogram and somatosensory evoked potentials monitoring were regularly used. Microvascular doppler ultrasonography and indocyanine green videoangiography were used to assess blood flow in parent and branch vessels. Results Seventy-three aneurysms were directly clipped, 6 were trapped and 1 was wrapped. Thirty-three aneurysms were coiled and 26 were coiled assisted with stents. At discharge, 71 of the 80 (88.8%)surgical treated patients had Glasgow Outcome Scale score of 4 or 5 points, 3 points in 6 patients (7.5%), 2 points in 1 patient (1.2%), and 1 point in 2 patients(2. 5% ). Fifty-four out of 59 cases underwent endovascular treatment scored 4 or5 points(91.5%)and 3 points in 5 patients (8.5%). Conclusions Surgical clipping and endovascular coiling are two major treatment choices for intracranial aneurysms. The treatment option should be individualized based on the patients' specific conditions, which could have a safe, effective and durable outcome.