经翼点入路急诊显微手术治疗破裂大脑中动脉瘤的策略

发布时间：2018-12-12 15:08

【摘要】：目的探讨经翼点入路急诊显微神经外科手术治疗破裂大脑中动脉瘤的策略。方法 30例大脑中动脉瘤破裂伴有脑内血肿患者,术前急诊行CTA确定动脉瘤的位置、大小,在发病24 h内(入院后6 h内)控制性降压下急诊经翼点入路显微手术治疗,其中29例行动脉瘤夹闭+血肿清除术,另有1例无法夹闭,只行单纯血肿清除,术后再行动脉瘤栓塞术。结果 30例患者手术顺利,脑内血肿量为(26.4±7.21)ml;术后复查血肿清除满意,2例出现脑血管痉挛;术后随访6个月至3年,恢复良好25例,死亡1例,植物生存1例,重残1例,中残2例。结论对于脑内血肿量大于30 ml或中线移位大于1 cm的破裂大脑中动脉瘤患者,采用经翼点入路显微手术清除血肿和夹闭动脉瘤,具有解除脑内血肿占位效应、防止动脉瘤再次破裂出血、术后神经功能障碍发生率降低的优点。
[Abstract]:Objective to explore the treatment strategy of ruptured middle cerebral artery aneurysm (MCAA) via pterygoid approach. Methods Thirty patients with rupture of middle cerebral artery aneurysm associated with intracerebral hematoma were treated with CTA to determine the location and size of aneurysm before operation. Under controlled hypotension within 24 hours of onset (within 6 hours after admission), emergency microsurgery via pterygoid approach was performed. Among them, 29 cases underwent clipping hematoma removal, the other 1 case could not be clipped, only simple hematoma clearance was performed, and then embolization of aneurysm was performed after operation. Results the operation was successful in 30 patients, the amount of intracerebral hematoma was (26.4 卤7.21) ml;, the clearance of hematoma was satisfactory, and the cerebral vasospasm occurred in 2 cases. After 6 months to 3 years follow-up, 25 cases recovered well, 1 case died, 1 case survived, 1 case was severely disabled, 2 cases were middle disability. Conclusion for patients with ruptured middle cerebral artery aneurysms whose hematoma volume is more than 30 ml or midline displacement is more than 1 cm, microsurgical removal of hematoma and clipping aneurysm via pterygoid approach has the effect of relieving intracerebral hematoma. The advantage of preventing rerupture of aneurysm and decreasing incidence of neurological dysfunction after operation.
【作者单位】：安徽医科大学附属省立医院神经外科安徽省脑功能与脑疾病重点实验室;
【分类号】：R651.1

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