Microsurgery Treatment of Aneurysmal Subarachnoid Hemorrhage_West China Medical Journal

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Department of Neurosurgery, People’s Hospital of Leshan, Leshan, Sichuan 614000, P.R.China;

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Keywords：

颅内动脉瘤; 蛛网膜下腔出血; 翼点入路; 显微外科

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【摘要】目的 探讨基层医院显微外科手术治疗动脉瘤性蛛网膜下腔出血（aSAH）的手术时机、方法以及疗效。方法回顾分析2005年1月-2009年12月经翼点入路行显微外科手术治疗的36例aSAH患者的临床资料。结果所有aSAH患者经数字减影血管造影检查确诊，均行瘤颈夹闭术。手术效果按GOS评分，恢复良好30例（83%）、中度残疾4例（11%）、死亡2例（6%）。结论 aSAH按Hunt-Hess分级为Ⅰ～Ⅱ级的患者应尽早手术， Ⅲ～Ⅳ级应结合患者颅内出血量及全身状况综合考虑，Ⅴ级待病情稳定后积极手术治疗。经翼点入路显微外科手术治疗前循ASAH，手术中暴露清楚，夹闭瘤颈可靠，疗效满意。
【Abstract】 Objective To explore the operative time, methods and curative effect of microsurgical treatment on aneurysmal subarachnoid hemorrhage (aSAH) in basic-level hospitals. Methods The data of 36 patients with aSAH who had undergone microsurgery from January 2005 to December 2009, were retrospectively analyzed. Results All the patients were confirmed as aSAH by digital subtraction angiography, and all of them had undergone clapping of aneurism. According to GOS, 30 patients (83%) had good recovery, four patients (11%) had moderate disability and two patients (6%) died. Conclusions The operation should be done as early as possible in the patients with gradeⅠ-Ⅱ of Hunt-Hess, the volume of intracranial hemorrhage and patient’s condition should be considered to decide when to operate of grade Ⅲ-Ⅳ, patients with grade Ⅴ aneurysms should be treated by conservative therapy first. They should consider an operation only when their condition is stable after conservative therapy. The peritoneal approach is a good procedure because of clear exposure, reliable clipping and satisfactory results.

Citation： ZHANG Daobao,WAN Xiaoqiang,WEI Zhenghong,WANG Shan. Microsurgery Treatment of Aneurysmal Subarachnoid Hemorrhage. West China Medical Journal, 2010, 25(8): 1439-1441. doi: Copy

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4.	张建林, 姜汝明, 辛昌明, 等. 颅内动脉瘤的显微手术治疗（附32例报告）[J]. 泰山医学院学报, 2002, 23(1): 53.
5.	毛伯镛, 刘艳辉, 杨开勇. 131例颅内动脉瘤的显微手术治疗[J]. 华西医科大学学报, 2001, 32(3): 209-213.
6.	Leipzig TJ, Morgan J, Horner TG, et al. Analysis of intraoperative rupture in the surgical treatment of 1694 saccular aneurysms[J]. Neurosurgery, 2005, 56(3): 455-468.
7.	Xin T, Chen F, Lin J, et al. DSA 3D reconstruction in diagnosisand interventional treatment of anterior communicating arterial aneurysms[J]. J Clin Med Imaging Technol, 2004, 20(6): 929-931.
8.	Lorsheyd A, Simmers TA, Robles De Medina EO. The relationship between electrocardiographic abnormalities and location of the intracranial aneurysm in subarachnoid hemorrhage[J]. Pacing Clin Elect rophysiol, 2003, 26(8): 1722-1728.
9.	孙正辉, 许百男, 周定标, 等. 载瘤动脉临时阻断处理颅内动脉瘤的临床研究[J]. 中华神经外科杂志, 2003, 19(5): 361-363.
10.	赵新利, 周国胜, 周文科, 等. 后交通动脉瘤的手术体会及切除瘤囊对手术后动眼神经功能恢复的影响[J]. 医学信息(手术学分册), 2007, 20(5): 393-394.
11.	韩德清, 黄永凯, 孙培永, 等. 显微手术治疗大脑中动脉瘤[J]. 中国临床神经外科杂志, 2008, 13(5): 303-304.
12.	Loukas M, Louis RG Jr, Childs RS. Anatomical examination of the recurrent artery of Heubner[J]. Clin Anat, 2006, 19(1): 25-31.

1. 宋冬雷, 徐斌, 顾宇翔, 等. 动脉瘤破裂急性蛛网膜下腔出血的救治[J]. 中华脑血管病论坛, 2007, 5(3): 185-188.
2. 马廉亭. 动脉瘤性蛛网膜下腔出血的诊治规范[J]. 中国现代神经疾病, 2004, 4(1): 121-123.
3. 张义松, 罗祺. 颅内动脉瘤显微手术及血管内治疗（305例报告）[J]. 中国临床神经外科杂志, 2007, 12(2): 76-78.
4. 张建林, 姜汝明, 辛昌明, 等. 颅内动脉瘤的显微手术治疗（附32例报告）[J]. 泰山医学院学报, 2002, 23(1): 53.
5. 毛伯镛, 刘艳辉, 杨开勇. 131例颅内动脉瘤的显微手术治疗[J]. 华西医科大学学报, 2001, 32(3): 209-213.
6. Leipzig TJ, Morgan J, Horner TG, et al. Analysis of intraoperative rupture in the surgical treatment of 1694 saccular aneurysms[J]. Neurosurgery, 2005, 56(3): 455-468.
7. Xin T, Chen F, Lin J, et al. DSA 3D reconstruction in diagnosisand interventional treatment of anterior communicating arterial aneurysms[J]. J Clin Med Imaging Technol, 2004, 20(6): 929-931.
8. Lorsheyd A, Simmers TA, Robles De Medina EO. The relationship between electrocardiographic abnormalities and location of the intracranial aneurysm in subarachnoid hemorrhage[J]. Pacing Clin Elect rophysiol, 2003, 26(8): 1722-1728.
9. 孙正辉, 许百男, 周定标, 等. 载瘤动脉临时阻断处理颅内动脉瘤的临床研究[J]. 中华神经外科杂志, 2003, 19(5): 361-363.
10. 赵新利, 周国胜, 周文科, 等. 后交通动脉瘤的手术体会及切除瘤囊对手术后动眼神经功能恢复的影响[J]. 医学信息(手术学分册), 2007, 20(5): 393-394.
11. 韩德清, 黄永凯, 孙培永, 等. 显微手术治疗大脑中动脉瘤[J]. 中国临床神经外科杂志, 2008, 13(5): 303-304.
12. Loukas M, Louis RG Jr, Childs RS. Anatomical examination of the recurrent artery of Heubner[J]. Clin Anat, 2006, 19(1): 25-31.

West China Medical Journal

Microsurgery Treatment of Aneurysmal Subarachnoid Hemorrhage

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