显微外科手术治疗颅内动脉瘤25例

目的：总结25例颅内动脉瘤的显微外科手术治疗经验，探讨显微手术技巧及动脉瘤破裂的处理。方法：在气管插管全麻及控制性低血压下，依据动脉瘤的部位选择手术入路，在显微镜直视下操作，解剖动脉瘤颈，稳妥夹闭瘤蒂，结果：本组25例中术后恢复工作19例（76％），轻残3例，重残2例，死亡1例，并发脑积水2例，水灶性脑梗塞2例。结论：显微神经外科技术使颅内动脉瘤手术成功率明显提高，采用控制性低血压和暂时阻断载瘤动脉是降低术中动脉瘤破裂出血和术后病人致残及死亡的重要措施。脑积水是最常见并发症，需行V－P分流。

Experience in Microsugical Treatment of 25 Cases of Intractranial Aneurysms

Objectives To summarize the experiences in the microsurgical treatment of the intracranial aneurysm and to discuss microsurgical technique and treatment of the ruptured aneurysm.Methods Under controlled low blood pressure and endotracheal intubation anesthesia,the optimal operative approaches were chosen according to the position of the aneurysm.All the procedure of the surgery and placing aneurysm clips were performed under the operative microscope.Results Of 25patients with intracranial aneurysms,19recovered to normal work after the operation,3were mildly disabled,2severely disabled and1died.Hydrocephalus occurred in2cases and small focal cerebral infarction in2cases.Conclusions Microsurgical technique can improve the successful rate of the operation for the intracranial aneurysm.In order to reduce the rupture and blooding of the aneurysm during the operation,and the rate of postoperative disability and death,it is the necessary to apply the controlled hypotension and temporarily block the parent artery.Hydrocephalus,which would be treated by V-P shut,is the common postoperative complicaton in patients with intracranial aneurysms.