颅内多发动脉瘤的手术治疗

目的探讨颅内多发动脉瘤的诊断和治疗方法。方法回顾性分析我科诊治的21例颅内多发动脉瘤患者的临床资料。21例中发现动脉瘤43个,其中2个动脉瘤20例,3个动脉瘤1例。手术治疗18例：①一期手术一侧开颅16例,其中一侧翼点锁孔入路夹闭双侧后交通动脉动脉瘤3例;一侧翼点常规开颅13例,其中一次夹闭3个动脉瘤1例,夹闭2个动脉瘤8例,夹闭加包裹2例,夹闭一个动脉瘤2例。②二期双侧开颅手术2例。2例血管内栓塞治疗。1例未破裂动脉瘤患者拒绝手术出院。结果术后20例全部存活,恢复出院。15例随访4个月～6年,恢复正常生活或工作11例,轻偏瘫2例,重残1例,植物生存1例。1例双侧后交通动脉动脉瘤患者,因手术显露困难,未处理对侧病变,术后经过良好,拒绝再次手术,出院后第10个月突然昏迷死亡。结论对于颅内多发动脉瘤应及早手术治疗,即使是双侧或多部位的动脉瘤,在可能的情况下于一期手术中通过一个入路处理所有病变。

Surgical Management of Multiple Intracranial Aneurysms

Objective To explore the methods to diagnose and treat multiple intracranial aneurysms. Methods Clinical data of 21 patients with multiple intracranial aneurysms, in whom 43 aneurysms were found, were analyzed retrospectively. There were 2 aneurysms in each of 20 patients, and 3 aneurysms were found in 1 patients. Of 18 patients undergoing the surgery, 16 were treated by one-stage operation though unilateral approach and 2 by two-stages operations through bilateral approach in 2 cases. The bilateral posterior communicating artery aneurysms were clipped via unilateral keyhole approach in 3 patients. One side routine pterional craniotomy was performed in 13 patients, of whom, 1 underwent an operation clipping 3 aneurysms, 8 underwent an operation clipping 2 aneurysms, 2 underwent an operation clipping and wrapping 2 aneurysms and 2 underwent an operation clipping 1 aneurysms. Four aneurysms were endovascularly embolized in 2 patients. However, one patient with unruptured aneurysms was discharged from hospital due to reluctance to treat. Results Twenty patients receiving the surgical or endovascular treatment were survived. Of 16 patients followed up from 4 months to 6 years, 11 returned to normal life or work, 2 had hemiparesis, 1 was severely disabled, 1 vegetably survived and 1 patient with bilateral posterior communicating artery aneurysms in whom an aneurysm contralateral to the operation was not treated due to surgical difficulties, and who refused second craniotomy in spite of relatively good recovery after the first surgical treatment, sudden lost self-consciousness and died 10 months after the dischange from hospital. Conclusions The patients with multiple intracranial aneurysms should be early surgically treated. It is possible to treat all the intracranial aneurysms by an operation through unilateral approach in most of the patients with bilateral or multi-position aneurysms.