摘要
目的探讨大脑前动脉远端(DACA)动脉瘤破裂出血后的CT影像特点及手术入路。方法回顾性分析2008年4月至2016年10月苏州大学附属第一医院神经外科就诊的47例DACA动脉瘤病人的临床资料,收集病人入院时的一般资料、Hunt?Hess分级、CT影像表现、治疗方案选择、手术入路、预后情况等数据进行统计学分析。结果47例病人中有32例为破裂动脉瘤,这部分病人均有蛛网膜下腔出血(SAH)的临床表现,CT上提示合并纵裂血肿的有9例,血肿破入脑室的6例,多发动脉瘤8例;接受显微手术治疗的有38例,术后病人预后良好(GOS评分4~5分)的25例,有严重神经功能障碍(GOS评分1~3分)的13例,包括1例死亡病人。结论DACA动脉瘤破裂出血的蛛网膜下腔出血最厚的部位主要在纵裂,相比于前交通动脉瘤位置常较高,易合并纵裂(脑叶)血肿和血肿破入脑室。DACA动脉瘤易合并多发动脉瘤。治疗以显微手术为主,术前Hunt-Hess分级较低的病人预后良好。
Objective To investigate the CT features of the ruptured anterior cerebral artery(DACA)aneurysm and surgical ap-proach.Method Retrospectively analyzed the clinical data of 47 patients with DACA aneurysms who were admitted to Department of Neurosurgery,The First Affiliated Hospital of Soochow University between April 2008 and October 2016.The general data,Hunt-Hess classification,CT imaging findings,and treatment plan were collected.Statistical analysis was performed on data such as selec-ion,surgical approach,and prognosis.Results Thirty-two of the 47 patients were admitted with aneurysm rupture and clinical man-estations of subarachnoid hemorrhage(SAH).In the CT images,there were 9 cases of hematoma locating in anterior longitudinal fissure,and 6 cases of hematoma breaking into the ventricle.There were 8 cases with multiple aneurysms;38 cases underwent micro-surgery,25 cases with good prognosis(GOS score 4-5 points),and 13 cases with severe neurological dysfunction(GOS score 1-3 points),including one patient died.Conclusions The thickest part of SAH in DACA aneurysm rupture is mainly in longitudinal fissure,which is often higher than that of anterior communicating aneurysm.It is easy to combine with longitudinal fissure hematomaor with hematoma breaking into the ventricle.DACA aneurysms are prone to have multiple aneurysms.The treatment was based onmicrosurgery,and patients with a lower Hunt-Hess grade before surgery had a good prognosis.
作者
徐建国
黄煜伦
孙春明
陈罡
王中
XU Jianguo;HUANG Yulun;SUN Chunming;CHEN Gang;WANG Zhong(Department of Neurosurgery,The First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215000,China)
出处
《安徽医药》
CAS
2020年第1期1-5,共5页
Anhui Medical and Pharmaceutical Journal
基金
国家自然科学基金青年项目（81701210)
关键词
颅内动脉瘤
大脑前动脉
动脉瘤
破裂
体层摄影术
X线计算机
脑血管重建术
Intracranial aneurysm
Anterior cerebral artery
Aneurysm,ruptured
Tomography,X-ray computed
Cerebral revascularization
