277例颅内动脉瘤的显微外科手术治疗

目的探讨颅内动脉瘤的手术策略、术中脑保护以及疗效等。方法采用夹闭、切除、孤立、包裹等方法手术处理277例共312个动脉瘤。其中在低温停循环条件下手术夹闭5例,行动脉瘤孤立3例,行动脉瘤包裹2例。结果277例中,127例术后行DSA检查,绝大多数动脉瘤夹闭满意。按GOS标准,良好243例(87.7%),差13例,死亡21例。189例得以随访,恢复良好180例(95.2%),中残或重残7例,死亡2例。结论手术夹闭是治疗动脉瘤的确实有效的方法。对复杂性颅内动脉瘤,需采用充分的显露,血管临时阻断,有效的脑保护,动脉瘤切开减压,缩窄瘤颈瘤体成型或载瘤动脉的塑型等措施,方能达到满意的手术效果。

Microsurgical Treatment of Intracranial Aneurysms: Experience in 277 Patients

Objective To study the surgical techniques, intraoperative cerebral protection, and curative effect in patients with intracranial aneurysms. Methods Three hundred and twelve aneurysms were treated by clipping, resecting, trapping and coating in 277 patients, among whom, 5 were treated by trapping or coating the aneurysms under deep hypothermic circulatory arrest. Results The postoperative DSA examination in 127 cases showed that most of the aneurysms were clipped successfully. According to GOS standard, the outcome in the early stage was good in 243 cases (87.7%), poor in 13 cases, and 21 died. Long-term follow-up was performed in 189 patients, of whom, 180 (95.2%) were recovered well, 7 moderately or severely disabled, and 2 died. Conclusions Surgical clipping was the most effective method to treat intracranial aneurysm. The measures to heighten curative effect of surgery on the complex aneurysms include sufficient exposure, temporary occlusion of the parent artery, effective cerebral protection, reduction of intraaneurysmal pressure, remodeling technique, reconstruction of the parent artery and so on.