【摘要】 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。更多还原

【Abstract】 Objective To evaluate the microsurgical techniques and optimal moment for surgical management of intracranialaneurysms. Methods Fifty Cases were diagnosed as having ruptured aneuryoms at the anterior portion of Willis circle (Hunt -Hess grading Ⅰ - Ⅴ) . Most of the patients came to our department with typical clinical manifestations of subarachnoid hemorrhage.Surgical measures were carried out within 12 - 72 hrs, and Yasargil’s transpterional approaches were taken for the surgery. ResultsOf the 50 cases, 38 (76%) were cured, 5 significantly improved, 3 lost consciousness and 4 patients died (8% ) . ConclusionsOnce the patients with subarachnoid hemorrhage were diagnosed as having ruptured aneurysm, surgical measurce should be takenearly. Skilled microsurgical technigues and optimal moment of operation were the key to successful treatment of the disease andYasargil’s transpterional approach might be the appropriate choice for the surgery.更多还原