颅内动脉瘤520例手术治疗的临床分析

【摘要】 本文分析了手术治疗的520例颅内动脉瘤的部位、形态、大小,并存疾患、动脉痉挛及出血情况。颈内一后交通支动脉瘤占53.6％,前交通支动脉瘤占16％。动脉瘤的形态以球形最多;其次是葫芦形。动脉瘤表面有局部膨出者最易出血。76％的动脉瘤大小为5～14mm,这种普通动脉瘤比大型及巨型的容易出血。第1次出血后任何时间皆有发生第2次出血的可能,46.55％的病人第2次出血是在第1次出血14天之后发生。动脉瘤出血后血管造影发现30.71％出现动脉痉挛,以出血后第6～15天最多,占同期造影的47.01％;64.96％的动脉痉挛发生于载瘤动脉近端。额颞直线切口及4cm~2骨窗可直接处理Willis氏动脉环的大多数动脉瘤,特别对其多发动脉瘤很有用。对重要动脉的巨型动脉瘤孤立前,行颅内-外动脉吻合。一例巨型基底动脉瘤由对侧夹闭瘤蒂成功。更多还原

【Abstract】 Fire hundred and twenty cases of operated intracranial aneurysm were analized about their location, shape, size, coexistent diseases, vascular spasm and bleeding. Carotid-posterior communicating artery aneurysm made up 53.6％ whereas anterior communicating artery aneurysm, 16％. The most common shape was saccular type (64.6％) and the next, calabash-like (28.6％). The aneurysm with a local bulging is more prone to bleed. Ordinary aneurysms which are less than 15mm in size comprised 76％ of all cases and were more probable to bleed than larger ones. The secondary hemorrhage might occur at any time after the first attack, the shortest interval being one day and the longest 18 years, but 40.55％ occured 14 days after the primary hemorrhage. Vessel spasm most commonly appeared 6 to 15 days after the first attack and were confirmed by angiography in 30.71％ of the cases. 64.96％ of spasm are onthe parent vessel proximal to the aneurysm.A straight linear fronto-temperal incision with a 4cm bone window is sufficient to deal with most aneurysms of the circle of Willis e. g. anterior com., posterior com., middle cerebral and basilar aneurysms, especially useful in the case of multi-aneurysm. The most important step is to expose the pedicle of the aneurysm by way of sharp dissection that would reduce bleeding to its minimum. Only when the pedicle has been clipped the other operation can be taken. For trapping a giant aneurysm on a major artery an extracranial and intracranial artery anastomosis was performed as a preliminary precedure which proved effective to pervent neurological disorders. Copper wire was induced successively into twe giant aneurysms, another giant aneurysm of the basilar artery was clipped using an opposite side approach and the patient recovered smoothly from her previous neurological deficits.更多还原