颅内动脉瘤破裂导致脑内血肿的诊断与治疗  

Diagnosis and treatment of intracerebral hematoma due to ruptured intracranial aneurysms

作　　者：李刚[1] 李新钢[1] 徐淑军[1] 江玉泉[1] 王云彦[1] 贾德泽[1] 刘青林[1] 苏雨行[1] 王东海[1] 

机构地区：[1]山东大学齐鲁医院神经外科,山东济南250012

出　　处：《中华神经外科疾病研究杂志》2008年第6期541-544,共4页Chinese Journal of Neurosurgical Disease Research

基　　金：山东省卫生系统中青年重点科技人才基金资助项目(1020工程)

摘　　要：目的探讨颅内动脉瘤破裂导致脑内血肿的诊断和治疗原则。方法本组男15例,女12例,年龄18～67岁,平均51岁。27例脑内血肿均经脑血管造影(DSA)或CT脑血管造影(CTA)检查确诊,其中前交通动脉瘤7例,后交通动脉瘤10例,大脑中动脉瘤9例,后交通动脉瘤合并大脑中动脉瘤1例。本研究对其临床表现、影像学特点及处理原则分别进行了分析。结果27例患者中有24例行开颅动脉瘤夹闭及血肿清除术,2例行股动脉穿刺血管内弹簧圈栓塞治疗,1例行DSA检查确诊动脉瘤后术前准备时再出血,抢救无效死亡。根据GOS分级,本组Ⅰ级3例,Ⅱ级1例,Ⅲ级3例,Ⅳ级7例,Ⅴ级13例。结论某些特殊部位的自发性脑内血肿,有可能是颅内动脉瘤破裂出血所致,需尽早行DSA或CTA检查明确诊断,治疗以手术为首选,术中夹闭动脉瘤并将血肿清除。Objective To discuss the diagnosis and treatment of intracerebral hematoma （ICH） due to ruptured intracranial aneurysms. Methods In this retrospective study, twenty-seven patients of ICH following ruptured intracranial aneurysms were analyzed. There were 15 males and 12 females ranging from 18 ～ 67 years with the mean age of 51 years. All patients with ICH were diagnosed by CTA or DSA. Among these patients, 7 cases were anterior communicating artery aneurysms, 10 cases posterior communicating artery aneurysms, 9 cases middle cerebral artery aneurysms, and 1 case middle cerebral artery and posterior communicating artery aneurysm. Results A total of 24 patients were microsurgically treated by pterional approach to evacuate ICHs and to clip the ruptured aneurysms. Two patients accepted endovascular embolization. One patient died before surgery due to re-rupture of aneurysm. According to Glasgow Outcome Scale, there were 3 cases in grade Ⅰ, 1 case in grade Ⅱ, 3 cases in grade Ⅲ, 7 cases in grade Ⅳ, and 13 cases in gradeⅤ. Conclusion Preoperative angiography or CTA are essential for the correct diagnosis of ICHs due to ruptured intracranial aneurysms. Early surgical management should be performed to evacuate ICHs and to clip the ruptured aneurysms.

关 键 词：颅内动脉瘤 脑内血肿 外科手术 

分 类 号：R743[医药卫生—神经病学与精神病学]