摘要
目的探讨大脑中动脉(MCA)动脉瘤的临床特点及手术方法。方法回顾性分析108例MCA动脉瘤的临床特点、影像学特征及手术方法。9例未破裂动脉瘤MRI检查表现为中颅窝占位,99例破裂动脉瘤CT检查均示蛛网膜下腔出血。入院时患者Hunt-Hess分级:0级9例,Ⅰ级3例,Ⅱ级21例,Ⅲ级58例,Ⅳ级15例,Ⅴ级2例。脑血管造影提示MCA主干动脉瘤10例,分叉部92例,MCA远端6例,均经改良翼点入路进行手术。结果动脉瘤夹闭93例,动脉瘤切除7例,夹闭加包裹8例。2例术前Hunt-Hess分级Ⅴ级病人,术后1例死亡,1例植物生存;术前Hunt-Hess分级Ⅳ级的15例病人中,11例长期昏迷。随访6～36个月,平均随访14.3个月,按照GOS评定预后,其中5分为40例,4分48例,3分7例,2分12例,1分1例。结论 MCA动脉瘤的治疗首选动脉瘤夹闭术,术中保护MCA及保持周围相关血管的通畅是手术的关键。
Objective To explore the clinical characteristics and microsurgical managements of middle cerebellar artery （MCA） aneurysms. Methods The clinical data of 108 patients with MCA aneurysms, of whom, 9 had unruptured aneurysms and 99 ruptured ones, were analyzed retrospectively, including the clinical manifestation, imaging features, operative method and so on. The cerebral arteriographies revealed that of 108 aneurysms, 10 locatdd at proximal MCA, 92 at MCA bifurcations and 6 at distal MCA. Results Of 108 aneurysms, 93 were successfully clipped, 7 were resected, and 8 were clipped and wrapped. The following-up from 6 to 36 months shows that 88 were recovered well （including 40 patients with GOS 5 points and 40 with GOS 4 points）, 7 severely disabled （GOS 3 points）, 12 survived vegetatively （GOS 2 points） and 1 died （GOS 1 point）. Conclusions The craniotomy for clipping the aneurysms should be selected firstly in the patients with MCA aneurysms. The intraoperative protection of MCA and relative vascular branches is the key to good prognoses in the patients with MCA aneurysms treated by microsurgery.
出处
《中国临床神经外科杂志》
2012年第12期713-715,共3页
Chinese Journal of Clinical Neurosurgery
基金
江苏省医学重点学科基金项目(NO:xk2007227)
关键词
大脑中动脉
动脉瘤
显微外科
蛛网膜下腔出血
疗效
Middle cerebellar artery
Aneurysms
Mierosurgery
Subarachnoid hemorrhage
Curative effect
