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。
Objective To explore the operation strategy of ruptured middle cerebral artery aneurysms by pterional approach. Meth- ods Thirty cases of patients with ruptured middle cerebral artery aneurysm accompanied with intracerebral hematoma were adopted by preop- erative emergent CTA to determine the location and size of aneurysm, following （26.4 ＋ 7.21 ） ml of the hematoma volume. During 24 hours of onset, the patients were exerted by microneurosurgery via pterion approach undergoing controlling blood pressure to ideal index within 6 hours of inpatient, 29 cases received aneurysm occlusion and evacuation of hematoma, and 1 case was exerted only simple hematoma with the impossible occlusion and embolizated after operation. Results All patients were followed up for 6 months to 3 years, among whom there were 25 cases of recovery, 1 case of death, 1 case of persistent vegetation state, 1 case of severe disability, and 2 cases of moderate disability. Conclusion According to the patients with ruptured cerebral aneurysms accompanied by 30ml of intracerebral hematoma volume and 10ram of median line excursion, it would be feasible and effective in removing the hematoma and clipping of the aneurysm via pterional approach, by relieving the volume effect of hematoma, preventing the rerupture of aneurysm, and lowering the postoperative neuro - dysfunction.
出处
《安徽医学》
2013年第9期1293-1295,共3页
Anhui Medical Journal
关键词
大脑中动脉动脉瘤
颅内血肿
显微手术
翼点
Middle cerebral artery aneurysms
Intracranial hematoma
Microsurgery
Pterion
