并发颅内血肿的颅内动脉瘤161例

本文报告161例合并颅内血肿的颅内动脉瘤,占同期破裂动脉瘤患者的44.9%。临床和 CT 资料分析表明,前交通动脉和椎基动脉系统的动脉瘤易发生脑室内出血,而大脑中动脉和胼周动脉的动脉瘤易发生脑内血肿。治疗应根据颅内出血的类型。合并脑内大血肿者应急诊清除血肿,同时夹闭动脉瘤。合并大量脑室内出血者应作脑室外引流,待病情稳定后再行动脉瘤直接手术。此类患者预后差,死亡率为50.9%。经统计处理,发现影垧预后的主要因素包括年龄、入院时临床状况、动脉瘤部位、蛛网膜下腔出血量、脑室内出血程度,以及颅内出血的类型。

161 Patients with Rupture of Aneurysm Associated with Intracranial Hematoma

This is a retrospective analysis of 161 cases of ruptured intracranial aneurysm associated with intracranial hematoma,including intracerebral hematoma and intraventricular hemorrhage,collected over 6 years in the neurosurgical depart- ment of Salp etrie re Hospital in Paris.The intraventricular hemorrhage occurred predominantly in cases of ruptured ACoA and VBA aneurysms,and intracerebral hematoma,mainly in ruptured MCA and pericallosal artery aneurysms.Management of aneurysm with intracranial hematoma depends upon the type of hematoma and the condition of the patients.In case of a life threatening large hematoma,an emer- gent operation should be performed to evacuate the hematoma,and clip the ane- urysm in the same time.In case of intraventricular hemorrhage,external ventricu- lar drainage should be urgently done,and the aneurysm operation followed or dela- yed until the clinical condition improved.In our series the overall mortality rate as high as 50.9%.Chi-square test showed that the patients age,clinical conditions, site of the aneurysm,severity of the intracranial hemorrhage were the main prog- nostic factors affected the ultimate outcome of these patients.