显微外科手术治疗颅内破裂微小动脉瘤的疗效分析

目的探讨显微外科手术治疗颅内破裂微小动脉瘤的安全性和疗效。方法对73例DSA影像显示直径〈5mm的颅内破裂动脉瘤患者的临床资料进行回顾性分析,总结颅内破裂微小动脉瘤的治疗策略,并分析早期显微外科手术的治疗效果。病例随访采用DSA（46例）或磁共振血管造影（11例）,随访时间为术后3个月至4年。结果术前经DSA诊断的73例79个动脉瘤,经手术探查证实并给予处理的77个;未处理的2个动脉瘤中1个未予探查（多发性动脉瘤）,另1个为A2段分支动脉瘤,术中未探查到。行手术处理的77个动脉瘤中单纯包裹术的有3个、单纯夹闭术的有59个、夹闭加包裹术的有12个、烧灼后包裹的有2个、行动脉瘤切除的有1个。术后格拉斯哥预后评分,5分的有59例,4分的有10例,3分的有2例,2分的有1例,1分的有1例。1例行包裹术的动脉瘤较前稍增大,2例夹闭术的动脉瘤颈部轻度复发,其余动脉瘤未见复发。结论显微外科手术治疗颅内破裂微小动脉瘤是一种安全、有效、可行的方法,对DSA不能证实,但具有明确动脉瘤破裂征象的自发性蛛网膜下腔出血可积极开颅探查。

Efficacy of microsurgery for treatment of ruptured intracranial microaneurysms

Objective To investigate the safety and efficacy of microsurgery for treatment of ruptured intracranial microaneurysms. Methods 73 patients with intracrmlial aneurysms 〈 5 nun detected by digital subtraction angiography （DSA） imaging were analyzed retrospectively. The therapeutic strategies of intracranial microaneurysms were summarized, and the effects of early microsurgery were analyzed. Results Seventy-three patients with 79 aneurysms were diagnosed by DSA before the operation, and 77 of the aneurysms were confirmed by the surgery. Of the 2 untreated aneurysms, one was in a patient with 2 aneurysms, one was treated the other aneurysm was on the contralateral side of the brain; the other patient with an aneurysm at A2 segment, and it was not found during the operation. Of the 77 treated aneurysms, 3 were wrapped, 59 were clipped, 12 were clipped and wrapped, 2 were wrapped after cauterization, and 1 was resected. According to the Glasgow Outcome Score （GOS） , 59 patients had a score 5, 10 had score 4, 2 had score 3, 1 had score 2, and 1 had score 1. Fifty-seven patients were followed up by magnetic resonance angiography （MRA） or DSA for more than 3 months. One wrapped aneurysm was slightly larger than before, 2 clipped aneurysms had neck remnants, and the remaining aneurysms were all cured. Conclusions Microsurgery for treatment of ruptured intracranial microaneurysms is a safe, effective and feasible method, it should be performed actively in patients with aneurysmal subaraehnoid hemorrhage.