动脉瘤性蛛网膜下腔出血脑疝患者的急诊显微手术治疗

目的总结动脉瘤性蛛网膜下腔出血脑疝患者的急诊显微手术治疗临床经验。方法 26例蛛网膜下腔出血脑疝患者均急诊行动脉瘤夹闭＋去骨瓣减压术。10例术前明确为动脉瘤性蛛网膜下腔出血脑疝的患者,16例怀疑为动脉瘤性。结果颈动脉动脉瘤4例,中动脉动脉瘤15例,前交通动脉瘤7例。动脉瘤夹闭及去骨瓣减压术均顺利完成。随访3～6个月,根据GOS评分标准,恢复良好5例,中残6例,重残5例,植物生存5例,死亡5例。结论对于术前可以明确为动脉瘤性蛛网膜下腔出血脑疝的患者应积极行急诊动脉瘤夹闭及去骨瓣减压术治疗,对于怀疑为动脉瘤性蛛网膜下腔出血脑疝的患者应仔细分析CT后积极行手术探查。

Emergency microsurgery for treatment of brain hernia resulting from subarachiond hemorrhage

Objective To summarize clinical experiences of microsurgery for treatment of brain hernia resulting from subarachiond hemorrhage in emergency period. Methods Decompressive craniectomy and aneurysm clipping were performed in emergency period in a series of 26 patients of brain hernia resulting from subarachiond hemorrhage（diagnoises was preoperatively confirmed in 10 and hypothermia was applied to 15）. Results Ruptured aneurysms were located on the internal carotid artery in 4 and the middle cerebral artery in 15 patients and anterior communication artery in 7 patients.All aneurysms were clipped and decompressive craniectomy were performed successfully.All patients were followed from three months to six months.The Glasgow Outcome Scale on discharge showed good recovery,moderate recovery,severe disability,vegetative state,and death in 5（19.2%）,6（23.1%）,5（19.2%）,5（19.2%）,and 5（19.2%）,respectively. Conclusion Aneurysms clipping and decompressive craniectomy is an important method to treatment of patients of brain hernia resulting from subarachiond hemorrhage.The preoperative CT should be analyzed carefully for patients of brain hernia resulting from subarachiond hemorrhage without preoperative diagnosis of aneurysms.