早中期手术辅助抗血管痉挛药物治疗颅内破裂动脉瘤

目的 总结颅内破裂动脉瘤合并蛛网膜下腔出血的早中期手术治疗经验。方法 1998年11月～2002年8月施行早中期手术治疗破裂动脉瘤合并蛛并网膜下腔出血患者40例,其中经翼点开颅侧裂入路或半球间入路行瘤蒂夹闭术39例;余1例为无明显瘤颈的床实上眼动脉段动脉瘤,行包裹术。手术后常规应用甘露醇,麻醉苏醒后立即应用扩血管解痉药物,持续治疗14d。结果 于发病后1个月根据GOS分级标准评估疗效,优21例(52.50％);良10例;差8例;死亡1例。手术后脑血管造影检查显示,除1例前交通动脉动脉瘤、1例床突旁动脉瘤有小部分残颈,其余38例患者动脉瘤均消失,而且原有脑血管痉挛症状减轻或消失。除2例出现脑血管痉挛症状外,余均未发生明显的手术后并发症。结论 在颅内动脉瘤破裂的早期施行手术治疗,可尽早解除再出血的危险;围手术期辅助应用抗血管痉挛及扩容药物治疗,可使患者获得较好疗效。

Early and intermediate operation combined with antivasospasm agents in the treatment of ruptured intracranial aneurysm

Objective To summarize the experiences of early and intermediate surgical treatment in patients with ruptured intracranial aneurysms (ICA) associated with subarachnoid hemorrhage. Methods During November 1998-August 2002, 40 patients with ruptured intracranial aneurysms were performed by early or intermediate operations with pterional or interhemispheric approaches, 39 aneurysms were clipped and the other one originated from supraclinoidal optic segment of the ICA was wrapped. Mannitol was routinely administrated postoperatively. Antivasospasm agents were immediately administrated after patients' awakening from anesthesia and persisted for 14 days. Results The therapeutic effects on patients were evaluated in 1 month after onset with Glascow outcome scale (GOS): excellent 21 cases (52.50%), good 10 cases, poor 8 cases and 1 death. The postoperative angiography demonstrated that aneurysms were disappeared in 38 patients and only 1 of anterior communicating artery aneurysm and another 1 of paraclinoidal aneurysm remained residue. Of the patients the underlining symptoms of cerebrovasospasm were abated or disappeared. The significant postoperative complications were not found except the cerebrovasospasm occurred in 2 cases postoperatively. Conclusion The early or intermediate surgical treatment in ruptured ICA may eliminate the risk of rebleeding as early as possible. The perioperatively combined with antivasospasm and hypervolemic agents may improve the therapeutic effect as well.