摘要
目的 探讨合并脑内血肿的低分级(Hunt-Hess分级Ⅰ~Ⅲ级)颅内破裂动脉瘤的手术方式、注意事项及并发症防治。方法 回顾性分析2013年至2023年收治的72例合并脑内血肿的低分级颅内破裂动脉瘤患者的临床资料。结果 显微夹闭术治疗43例,其中夹闭+血肿清除术24例,夹闭+血肿清除+去骨瓣减压术19例。血管内栓塞治疗29例,其中栓塞+钻孔引流术4例,栓塞+血肿清除+去骨瓣减压术5例,单纯栓塞治疗20例。出院时,显微夹闭术后预后良好34例(79.1%),预后不良9例(包括重残4例、植物状态4例、死亡1例),血管内栓塞治疗预后良好25例(86.2%),预后不良4例(包括重残3例、死亡1例)。术后随访3~21个月,中位随访时间6个月;DSA或CTA随访显示,34例夹闭术后动脉瘤完全闭塞,无复发;25例血管内栓塞术后完全栓塞24例(96.0%)、复发1例(4.0%)。结论 合并脑内血肿的低分级颅内破裂动脉瘤,应根据患者具体情况个体化选择手术方式,显微夹闭术或血管内栓塞治疗的预后均较好。
Objective To explore the surgical strategies,technical considerations,and complications management for treating low-grade(Hunt-Hess gradesⅠ~Ⅲruptured intracranial aneurysms combined with intracerebral hematoma.Methods The clinical data of 72 patients with low-grade ruptured intracranial aneurysms and concurrent intracerebral hematoma admitted between 2013 and 2023 were retrospectively analyzed.Results Microsurgical clipping was performed in 43 cases(clipping+hematoma evacuation in 24 cases;clipping+hematoma evacuation+decompressive craniectomy in 19 cases).Endovascular coiling was performed in 29 cases(coiling+hematoma drainage in 4 cases;coiling+hematoma evacuation+decompressive craniectomy in 5 cases;coiling alone in 20 cases).At discharge:the microsurgical clipping group had 34 cases(79.1%)with favorable outcomes and 9 cases(20.9%)with unfavorable outcomes(4 severe disabilities,4 vegetative states,1 death);the endovascular coiling group had 25 cases(86.2%)with favorable outcomes and 4 cases(13.8%)with unfavorable outcomes(3 severe disabilities,1 death).Postoperative follow-up(median 6 months,range 3–21 months)revealed:imaging(DSA/CTA)confirmed complete aneurysm occlusion in 34 clipping cases without recurrence;in the coiling group,24/25 cases(96.0%)achieved complete occlusion,with 1 recurrence(4.0%).Conclusion For low-grade intracranial ruptured aneurysms with intracerebral hematoma,the surgical approach should be individualized based on the specific condition of the patient.Both microsurgical clipping and endovascular embolization have good prognoses.
作者
孙奇
边世春
安学锋
王翼
秦杰
蔡彦超
刘洋
雷颉
杨铭
黄河
马廉亭
SUN Qi;BIAN Shi-chun;AN Xue-feng;WANG Yi;QIN Jie;CAI Yan-chao;LIU Yang;LEI Jie;YANG Ming;HUANG He;MA Lian-ting(Department of Neurosurgery,General Hospital of Central Theater Command,Wuhan 430070,China;Department of Neurosurgery,The 985th Hospital of the Joint Logistic Support Force,Taiyuan 030001,China)
出处
《中国临床神经外科杂志》
2025年第4期193-198,共6页
Chinese Journal of Clinical Neurosurgery
