合并脑室出血铸型的Hunt-Hess Ⅳ-Ⅴ级破裂前交通动脉瘤的超早期血管内栓塞治疗

目的总结血管内栓塞治疗合并脑室出血铸型的Hunt-HessⅣ-Ⅴ级破裂前交通动脉瘤的初步经验。方法8例破裂前交通动脉瘤48h内进行血管内介入栓塞治疗,其中2例采用电解可脱弹簧圈（GDC）,4例采用水解可脱弹簧圈（TRUFILL DCS Orbit）,2例采用水凝胶弹簧圈（HES）技术,术毕均行双侧脑室外引流,3例术后1月行脑室-腹腔分流术。结果7例动脉瘤致密填塞,1例大部填塞。出院时患者预后（GOS标准）：良好5例,中残2例,重残1例。结论虽然Hunt-Hess高分级破裂前交通动脉瘤患者病情危重,治疗风险很大,但积极地超早期血管内栓塞治疗辅以脑室外引流术是治疗的有效方法。

Ultra-early endovascular treatment of acutely ruptured poor-grade anterior communicating artery aneurysms with cerebral ventricular hemorrhage

Objective To summarize our experience on Endovascular treatment of acutely ruptured poor-grade （Hunt-Hess grade Ⅳ or Ⅴ） anterior communicating artery aneurysms with cerebral ventricular hemorrhage. Methads 2 aneurysms were embolized with GDCs,4 aneurysms were embolized with TRUFILL DCS Orbit,2 aneurysms were embolized with HES,after embolization the 8 cases were received external ventricular drainage. A permanent ventriculoperitoneal shunt was placed in 3 patients 1 month later. Results Total embolization was achieved in 7 and partial embolization in 1. Outcome was categorized using the Glasgow Outcome Scale （GOS） ： Ⅲ ： 1 patients,Ⅳ： 2,Ⅴ： 5. Conclusion Although the patients of acutely ruptured poor-grade anterior communicating artery aneurysms with cerebral ventricular hemorrhage are in poor neurological condition and high therapy risk, ultra-early Endovascular treatment combined external ventricular drainage is effective.