112例前循环动脉瘤诊治回顾

目的探讨现代技术条件下脑动脉瘤的诊断方法、治疗时机及几个值得注意的问题。方法总结应用现代神经外科技术诊治112例病人117个前循环动脉瘤的过程，对不同诊断手段、治疗方法、手术时机及结果进行评价。结果本组总体手术近期良好率为83.9％．病死率为4.5％。H—H动脉瘤分级0～2级的病例手术良好率为92．2％，其中蛛网膜下腔出血(SAH)后3d内手术良好率为77.8％．4-14d内手术良好率为92％，14d以后手术的病例中95.3％预后良好；3级良好率总体为66.7％，其中24h内手术良好率为100％，14d后于术良好率为88.9％；4～5级24h内手术良好率为55.6％，而4级14d后手术良好率为20％。结论CT脑血管造影可作为可疑动脉瘤性SAH的首选诊断方法。对于Hunt动脉瘤分级0-2级的动脉瘤应尽早手术。临床表现为2级，但CT显示出血量较多的病例在出血后4-14d手术效果不一定好；除可在SAH后数小时内手术外，3级病人应延期至14d以后手术为好。4～5级破裂动脉瘤在数小时内手术在技术上是可行的，效果很好。

Diagnosis and treatment review of 112 cases with aneurysms

Objective To reevaluate the diagnostic methods and treatment strategy of brain aneurysms under modern techniques. Methods 112 patients with 117 anterior circulation aneurysms operated by authors since 1993 were studied retrospectively. The diagnostic methods, timing of surgery and the results were reviewed. Results In this group, good result was obtained in 83.9% and mortality was 4.5%. For H-H grade 0-2, good result archived in 92.2%. Among them, good result was obtained in 77.8% of those who were operated within the first 72 hours, whereas 92% and 95.2% for the 4-14 day and after 14 days of SAH respectively. For H-H grade 3, good result was 66.7% in general (100% for first 24 hours, 33.3% for 24-72 hours, and 88.9% for 14 days later of SAH). For H-H 4-5, good result was 55.6% for first 24h operated, and 20% for 14days later of H-H 4. Conclusion We suggest that for H-H 0-2 aneurysms, operation should be performed as soon as possible, but if there was much blood in the cisterns the surgical result may not be good owing to later vessel spasm. For H-H 3, except operation within several hours, operation should be postponed to two weeks later. For H-H 4-5, operation within several hours may get fair result. Modern CTA could reveal more aneurysms with mini-invasive and more merits.