显微手术早期治疗破裂的前循环脑动脉瘤

目的旨在进一步提高早期手术治疗破裂的前循环脑动脉瘤的效果。方法回顾性分析早期显微手术治疗的112例破裂前循环脑动脉瘤患者的临床资料。结果112例病人，共125个脑动脉瘤，其中94个行动脉瘤颈夹闭，26个夹闭瘤颈后切除瘤体，另5个动脉瘤予以瘤壁包裹加固术。术后发生症状性脑血管痉挛16例，经积极治疗后，12例逐渐恢复，4例因大片的脑梗死而出现长时间昏迷。全部病例术后平均随访2年10个月，其中恢复良好92例，轻残16例，重残4例，无手术死亡。结论早期手术治疗破裂的脑动脉瘤，不仅可有效地防止再出血的危险，而且有利于脑血管痉挛的防治。术中一旦动脉瘤破裂，可采取暂时性阻断载瘤动脉和控制性低血压，但时间不宜过长。应用罂粟碱溶液冲洗脑池，扩充血容量，提升血压，高度扩张血管对防治脑血管痉挛具有相当好的疗效。

Microsurgery for Ruptured Intracranial Aneurysms in Anterior Circulation

Objective To improve curative effects of microsurgery on the ruptured intracranial aneurysms in the anterior circulation. Method Clinical data of 112 patients with ruptured intracranial aneurysms in the anterior circulation, who underwent microsurgery early after the rupture, were analyzed retrospectively. Results There were 125 aneurysms in 112 patients. Of 125 aneurysms, 94 were treated by clipping the neck of aneurysms, 26 by resection of aneurysmal body after clipping the neck, and 5 by wrapping. There were symptomatic eerebrovascular vessel spasms in 16 patients after the operation. The following up for 3.75 years showed that of 112 patients, 92 were recovered well, 16 mildly disabled and 4 severely disabled. Conclusions The rerupture of aneurysms may be prevented bv microsurgery early after the rupture which is helpful to preventing and treating cerebraovsascular spasms, in the patients with ruptured intraeranial aneurysms in the anterior circulation. Avoiding inactive separation and temporarily blocking parent artery is key to preventing intraoperative the rupture of aneurysms. Douching cistern by papaverine, expanding blood volume, elevating blood pressure, dilating vessel with drugs have good effects on cerebrovaseular spasms.