颅内巨大动脉瘤的显微手术治疗效果及远期随访

目的探索颅内巨大动脉瘤的手术治疗效果及远期预后情况。方法 我科行显做手术治疗的28例颅内巨大功脉瘤患者中，行动脉瘤颈夹闭并载瘸动脉塑形者24例，行动脉瘤孤立并血管重建术者1例，行动脉瘤包裹术者3例。结果患者出院时按COS评分，Ⅴ级17例，Ⅳ级5例，Ⅲ级3例，Ⅰ级3例。术后随访9月～8年，Ⅴ级17例，Ⅳ级5例，Ⅲ级1例，Ⅰ级5例，总有效率（Ⅴ级＋Ⅳ级）78．6％（22／28），死亡率17．9％（5／28）。结论颅内巨大动脉瘤的外科手术死亡率和致残率仍较高，对其治疗方式值得深入总结和探讨，以促进神经功能缺损的远期恢复，降低患者的致残率及术后再发风险，提高患者生存质量。

Surgical Treatment and Long-term Following up of Giant Intracranial Aneurysms

Objective To explore long-term curative effect of neurosurgery on giant intracranial aneurysms.Methods The clinical data of 28 patients with giant intracranial aneurysms,who underwent neurosurgery including direct clipping of the aneurysms and reconstruction of the parent arteries in 24 cases,trapping aneurysm in 1 and wrapping aneurysms in 3. were analyzed retrospectively.All the patients were followed-up from 9 months to 8 years.Results According on Glasgow Outcome Scale On discharge from hospital,of 28 patients,17 were recovered well,5 moderately disabled,3 severely disabled and 3 died.The data of following-up showed that of 25 patients,17 were recovered well,5 moderately disabled,1 severely disable and 2 died.The total effective rate was,78.6%(22/28)and the total mortality was 17.9%(5/28).Conclusions The surgical treatment of the giant intracmnial aneurysms is still difficult now.The strategies of surgery for the giant intracranial aneurysms should be further studied to reduce the morbidity and, improve the prognosis in the patients with giant intracranial aneurysms.