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目的 通过对50例Willis环前部动脉瘤(Hunt-Hess分级Ⅰ～Ⅴ级)的显微手术治疗,以探讨手术时机、手术技巧对术后疗效的影响。方法 对来我科首诊的自发性蛛钢膜下腔出血(SAH)的病人作头颅CT,对高度怀疑为颅内动脉瘤患者行全脑血管造影(DSA)检查,若确诊为颅内动脉瘤,争取12小时、最迟72小时内(但由外院转诊已错过急性期者均在两周后)经Yasargil’s翼点入路开颅行显微手术夹闭动脉瘤。结果 50例病人,治愈(正常工作+部分工作)38例(76％)、好转(生活自理)5例、植物生存3例、死亡4例(8％)。结论 颅内动脉瘤破裂引起SAH,经CT、DSA确诊后应争取早期手术。选择最佳手术时机、手术入路、掌握熟练的显微操作技术及脑血管显微解剖知识、尽量缩短控制性低血压时间以及不阻断载瘤动脉是手术成功的关键。
Objective To investigate the effect of operation timing and operation technique on postoperative efficacy of 50 cases of Willis ring anterior aneurysm (Hunt-Hess grading Ⅰ ~ Ⅴ grade) by microsurgical treatment. Methods A CT scan of patients with spontaneous subarachnoid hemorrhage (SAH) who came to our department for first visit was performed. Patients who were highly suspected of having intracranial aneurysms were examined with whole brain angiography (DSA). If they were diagnosed as intracranial arteries Tumor, for 12 hours, at the latest within 72 hours (but by the outpatient referral have missed the acute phase in two weeks after) by Yasargil’s wing point craniotomy microsurgery clipping aneurysm. Results Fifty patients were cured (normal work + partial work), 38 cases (76%), improved (self-care) in 5 cases, plant survival in 3 cases and death in 4 cases (8%). Conclusions The ruptured intracranial aneurysm causes SAH. Early diagnosis should be obtained after CT and DSA diagnosis. Choosing the best timing of surgery, surgical approach, mastery of micromanipulation techniques and knowledge of microvascular anatomy of cerebrovascular vessels, shortening the duration of controlled hypotension and not blocking the parent artery is the key to successful surgery.