前循环动脉瘤破裂伴颅内血肿和脑疝患者的CT特点和直接手术疗效  

Emergency surgery for cerebral hernia patients with CT manifestations of ruptured anterior circulation aneurysm combined with intracerebral hematoma

作　　者：王振宇[1] 黄光富[1] 李志立[1] 唐健[1] 

机构地区：[1]四川省人民医院神经外科,成都610072

出　　处：《中华神经医学杂志》2012年第3期273-275,共3页Chinese Journal of Neuromedicine

摘　　要：目的探讨前循环动脉瘤破裂出血伴颅内血肿、脑疝患者的CT表现和直接手术疗效。方法回顾性分析四川省人民医院神经外科自2007年12月至2010年12月收治的11例前循环动脉瘤破裂出血伴颅内血肿、脑疝患者的CT表现及治疗，分析前循环动脉瘤破裂形成血肿与动脉瘤位置关系及手术处理要点。结果本组患者颅内出血原因术中均证实为动脉瘤破裂出血，其中前交通动脉瘤2例，后交通动脉瘤3例，大脑中动脉瘤6例；多发动脉瘤2例，1例为大脑中动脉瘤f责任动脉瘤）合并同侧后交通动脉瘤，1例为后交通动脉瘤（责任动脉瘤）合并对侧大脑中动脉瘤；术后GOS分级显示Ⅴ级6例，Ⅳ级2例，Ⅲ级1例，Ⅱ级0例，Ⅰ级2例。结论依据前循环动脉瘤破裂出血伴颅内血肿、脑疝患者的CT表现，早期手术治疗效果满意。Objective To evaluate emergency surgery for cerebral hernia patients with CT manifestations of ruptured anterior circulation aneurysm combined with intracerebral hematoma. Methods A total of 11 cerebral hernia patients underwent emergency operation based on CT manifestations from December 2007 to December 2010 for acute intracerebral hematoma due to suspected aneurysm rupture. Three dimensional computer tomographic angiography （3D-CTA） was performed one week postoperation. The locations ofaneurysms were investigated to analyze relationship between CT manifestations and emergency surgery. Results The cause of intracerebral hematoma in the 11 patients proved to be aneurysms rupture. The aneurysm was located at the anterior communicating artery in 2 cases, at the posterior communicating artery in 3 and at the middle cerebral artery in 6. Of the 2 patients who harbored multiple aneurysms, one had a middle artery aneurysm （responsible） plus a homonymy aneurysm at the posterior communicating artery, the other bad an aneurysm at the posterior communicating artery （responsible） plus an opposite side aneurysm at the middle artery. Postoperative Glasgow Outcome Scale （GOS） showed gradeⅤ in 6 cases, grade Ⅳ in 2, grade Ⅲ in 1, gradeⅠ in 2. Conclusion CT manifestations are useful indications for emergency surgery, including direct craniotomy, hematoma evacuation and aneurysm clipping, in cerebral hernia patients with ruptured anterior circulation aneurysm combined with intracerebral hematoma.

关 键 词：颅内动脉瘤 前循环 脑内血肿 

分 类 号：R651.12[医药卫生—外科学]