外科手术与血管内栓塞治疗老年患者颅内动脉瘤的临床分析

目的观察开颅手术与血管内栓塞治疗老年患者颅内动脉瘤的疗效.方法选择65岁以上的破裂颅内动脉瘤患者74例,分为开颅手术组（26例）和血管内栓塞组（48例）.评价术后并发症及出院时格拉斯哥预后（GOS）评分结果,采用电话及门诊随访6个月至4年.结果开颅手术组术后有症状血管痉挛10例;脑积水行脑室-腹腔分流术5例,因迟发性血管痉挛性脑梗死和脑水肿死亡2例;出院时GOS评分恢复良好19例,较差5例,死亡2例.血管内栓塞组有症状血管痉挛17例;脑积水行脑室-腹腔分流术5例;死亡3例,其中2例死于迟发性血管痉挛性脑缺血和肺部感染,另1例死于弹簧圈脱出致大脑中动脉闭塞引起的大面积脑梗死;出院时GOS评分恢复良好33例,较差12例,死亡3例.两组比较GOS评分差异无显著性.结论开颅手术与血管内栓塞治疗临床疗效相似,但由于血管内栓塞是微侵袭治疗,应成为治疗老年动脉瘤的首选.老年动脉瘤患者两种治疗方式术后迟发性血管痉挛的发生率均较高,应予足够重视.

Surgical and endovascular treatment for elderly patients with ruptured intracranial aneurysm

Objective To observe the efficacy of craniotomy and endovascular embolization in for elderly patients with intracranial aneurysm. Methods Seventy-four patients (aged older than 65 years) with ruptured aneurysm were selected, and they were divided into craniotomy group (n=26) and endovascular embolization group (n=48). Their postoperative complications and the results Glasgow outcome scale (GOS) score were evaluated at discharge. The telephone and Outpatient Department follow-up period lasted for 6 months to 4 years. Results Ten patients presented with symptomatic vasospasm after operation in the craniotomy group; 5 patients had ventriculoperitoneal shunt because of hydrocephalus, 2 patients died because of delayed cerebral infarction, cerebral edema and herniation. Nineteen patients had better outcomes based on GOS score at discharge, 5 had poorer outcomes, and 2 died. Seventeen patients had symptomatic vasospasm in the endovascular embolization group; 5 had ventriculoperitoneal shunt because of hydrocephalus; 3 died, 2 of them die of delayed vasospastic cerebral ischemia and pulmonary infection, the other died of large cerebral infarction caused by middle cerebral artery occlusion that resulted from coil herniation. Thirty-three patients had better outcomes based on GOS score at discharge, 12 had poorer outcomes, and 3 died. There was no significant difference in GOS between the 2 groups. Conclusion The clinical efficacy between the craniotomy and the endovascular embolization was similar. However, because of endovascular embolization is minimally; it should be the first choice in the treatment of aneurysm in older patients. In addition, the incidence of postoperative delayed vasospasm is higher in older patients with aneurysm after being treated with the 2 therapeutic approaches. Therefore, a great attention should be paid to it.