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目的探讨前循环颅内动脉瘤破裂后病情危重(Hunt—Hess分级III级以上)伴脑内血肿形成病人的急诊手术治疗。方法回顾性研究分析10例入院后急诊手术(24小时内)Hunt—Hess分级III级以上伴脑内血肿形成的前循环破裂颅内动脉瘤病人的手术方式及预后,探讨超早期手术治疗的效果。结果 10例病人(Hunt—Hess分级III级3例Hunt—Hess分级IV级6例Hunt—Hess分级V级1例)均伴有脑内血肿形成,血肿量约20-30ml。手术均采用额颞扩大翼点入路,手术夹闭动脉瘤后清除血肿并去骨瓣减压,术后随访1-2年时间,预后按GOS分级:V级(恢复良好)4例;IV级(轻残生活自理)3例;III级(重残)2例;I级(死亡)1例。结论对于前循环颅内动脉瘤破裂致脑内血肿形成病情危重(Hunt—Hess分级III级以上)的患者,经早期(24小时以内)急诊手术夹闭动脉瘤,清除血肿并去骨瓣减压,90%(9例)病人可挽救生命,对此治疗效果满意。
Objective To investigate the emergency surgical treatment of patients with critical anterior circulation aneurysm rupture (Hunt-Hess grade III or above) with intracerebral hematoma formation. Methods The retrospective study was conducted to analyze the surgical methods and prognosis of 10 cases of anterior circulation ruptured intracranial aneurysm with Hunt-Hess grade III or higher after emergency operation (within 24 hours) after admission, and to explore the effect of ultra-early surgical treatment . Results 10 patients (Hunt-Hess Grade III 3 cases Hunt-Hess Grade IV 6 cases Hunt-Hess Grade V 1) were associated with intracerebral hematoma formation, hematoma about 20-30ml. Surgery were used to expand the frontotemporal pterional approach, the operation to remove the hematoma after clipping the aneurysm and bony flap decompression, after a follow-up of 1-2 years, the prognosis by GOS grading: V grade (good recovery) in 4 cases; IV Grade 3 (light disabled living) 3 cases; class III (severe disability) 2 cases; class I (death) in 1 case. Conclusions For patients with an intracerebral hematoma caused by anterior circulation intracranial aneurysm rupture (Hunt-Hess grade III or above), the aneurysm is removed by emergency surgery (within 24 hours), the hematoma is cleared and the bones are decompressed , 90% (9 cases) of patients can save lives, the treatment effect is satisfactory.