合并脑室出血的高级别前交通动脉瘤的超早期显微手术治疗  

Ultra early microsurgical treatment for anterior communicating artery aneurysm of high-grade combined intraventricular hemorrhage

作　　者：颉奎[1] 祝斐[1] 黄新[1] 余任喜 郭光亮[1] 王金鹏[1] 彭智翔 

机构地区：[1]解放军171医院神经外科,九江332000

出　　处：《临床神经外科杂志》2015年第5期321-323,327,共4页Journal of Clinical Neurosurgery

摘　　要：目的探讨超早期显微手术治疗合并脑室出血的Hunt-HessⅣ-Ⅴ级前交通动脉瘤的效果。方法 56例前交通动脉瘤破裂患者,均破入脑室系统,脑室出血铸型,或合并额叶血肿、急性梗阻性脑积水;所有患者均在24 h内急诊进行脑室外引流术,同时或随后进行前交通动脉瘤显微手术夹闭,去骨瓣减压治疗。结果患者出院时经格拉斯哥预后量表（GOS）评定,预后良好12例,轻残18例,重残11例,植物生存8例,死亡7例。结论虽然Hunt-Hess高级别前交通动脉瘤患者的病情危重,治疗风险很大,但积极地早期行显微手术夹闭辅以脑室外引流术治疗的效果较好,是其有效的治疗方法。Objective To explore the clinical effects of microsurgery for high-grade（ Hunt-Hess grade Ⅳ and Ⅴ） anterior communicating artery aneurysms combined intraventricular hemorrhage.Methods 56 cases of anterior communicating artery aneurysm ruptured or merged frontal hematoma.They were breaking into the ventricular system and created casts of intraventricular hemorrhage,acute obstructive hydrocephalus. All patients were performed within 24 h emergency ventricular drainage,of these,56 cases simultaneously or followed were treated by microsurgical anterior communicating artery aneurysm clipping and decompressive craniectomy. Results Of 56 patients with high-grade anterior communicating artery aneurysm combined intraventricular hemorrhage cases,12 recovered well,18 were moderately disabled,11 severely disabled,8 vegetatively survived and 7 died. Conclusions It is very risky to treat the patients with anterior communicating artery aneurysms ruptured of Hunt-Hess Ⅳ-Ⅴ grade,but it is an effective method of treatment by early microsurgical clipping and external ventricular drainage（ EVD）.

关 键 词：前交通动脉瘤 显微手术 脑室出血 

分 类 号：R651.1[医药卫生—外科学]