颅内复杂动脉瘤的手术治疗

目的 总结颅内复杂动脉瘤的手术治疗和临床效果。方法 对42例颅内复杂动脉瘤施行显微外科直视手术并用格拉斯哥结果量表（GOS）评定治疗结果。结果42例中37例行动脉瘤夹闭术，3例行孤立术，1例行包裹术，1例行载瘤动脉近端阻断。手术后早期恢复良好37例，重残3例，死亡2例。29例经4个月－7年随访，恢复良好或中残27例，重残和死亡各1例。结论 颅内复杂动脉瘤手术需要采取充分的显露、血管临时阻断、脑保护技术、动脉瘤切开减压、缩窄瘤颈和瘤体成形以及载瘤动脉塑形等综合措施，方能达到满意的手术效果。在未来的治疗中，手术与导管技术的结合是较为合理的模式，将有助于进一步提高颅内复杂动脉瘤的疗效。

Surgical treatment of complex intracranial aneurysms

Objective To provide modern surgical management of complex intracranial aneurysms and to evaluate its clinical outcome. Methods Direct microsurgical repair of complex intracranial aneurysms was performed in 42 patients. Glasgow outcome scale (GOS) was conducted to evaluate surgical outcome. Results Aneurysms were clipped in 37 cases, trapped in 3 cases, and wrapped in 1 case. Proximal parent artery was occluded in 1 case. At the time of hospital discharge, good outcomes(GOS scores of 4 or 5) were achieved in 37 cases, poor outcomes (GOS scores of 2 or 3) in 3 cases, and 2 patients died. A total of 29 cases were follow up in 4 months to 7 years, good outcomes were achieved in 27 cases, poor outcomes in 1 case and death in 1 case.Conclusions Until now surgical intervention of complex intracranial aneurysms is still very challenge and difficult. Multiple surgical techniques such as wide exposure, temporary occlusion of parent arteries, brain protection, decompression of aneurysms, shrinkage of wide aneurysmal neck, aneurysmorrhaphy and vessle plastic should be taken to get good outcome. In the future surgical treatment of complex intracranial aneurysms, combined operative and endovascular techniques in a complementary way is a useful management for the best prognosis.