颅内破裂动脉瘤的血管内早期治疗

目的探讨颅内动脉瘤破裂出血后的血管内早期栓塞治疗的安全性和临床疗效。 方法回顾性分析了张家港澳洋医院神经外科自2007年7月至2016年7月收治的40例颅内破裂动脉瘤患者的44个颅内破裂动脉瘤的临床资料、影像、早期血管内治疗的安全性、有效性；所有患者术前均行头颅CT扫描确认自发性蛛网膜下腔出血，并得到DSA检查确认。术后根据GCS评分、疾病预后使用GOS评分对患者预后进行评估。 结果40例患者有44个动脉瘤，用栓塞体积比（VER）评估可脱性弹簧圈栓塞动脉瘤的疗效。其中27例100%栓塞（61.4%），12例95%（27.2%），4例90%（9%），1例80%（2%）。未出现出现动脉瘤再破裂出血；出现脑血管痉挛12例（30%），经对症处理后病情缓解；出现迟发性脑积水2例（5%）；恢复良好者35例（79.5%），轻度残疾2例（5%），重度残疾2例（4.5%），1例死亡（2.5%）。随访时间3个月~3年，随访期间无再出血。 结论对于颅内动脉瘤破裂出血的患者，早期血管内介入治疗，可减少动脉瘤二次出血的机会，在术后及时引流蛛网膜下腔积血，及时清除血性脑脊液中的有害物质及蛛网膜下腔积血的分解物、以减轻脑血管痉挛及脑积水的机会，缩短病程改善了患者的预后，疗效较为满意。

Early intravascular treatment for ruptured intracranial aneurysms

ObjectiveTo discuss the safety and effectiveness of the early endovascular treatment for ruptured intracranial aneurysms. MethodsForty cases, who were diagnosed with aneurysmal subarachnoid hemorrhage by CT and DSA in Zhangjiagang Aoyang Hospital, were analysed retrospectively. All the patients were evaluated with GCS and GOS. ResultsForty-four intracranial aneurysms were found in 40 patients. The volume embolization ratio (VER) were used for assessing the effectiveness of embolization. A hundred percent embolization were found in 27 aneurysms (61.4%), 95% embolization in 12 aneurysms (27.2%), 90% embolization in 4 aneurysms (9%) and 80% embolization in 1 aneurysm (2%). No re-rupture happened. Twelve patients (30%) suffered cerebral vacular spasm. And delayed hydrocephalus occurred in 2 patients (5%). Thirty-five patients (79.5%) recovered well. Only 1 patient died. All the patients have been followed up for 3 months to 3 years. ConclusionEarly endovascular treatment for ruptured intracranial aneurysms is safe and effective. The incidence of aneurysm re-rupture can be reduced. Hemorrhagic CSF drainage can reduce the occurrence of cerebral vacular spasm and delayed hydrocephalus and good for the patient’s recovering.