[1]伍　杰　杨　铭　潘　力　蔡明俊　刘　鹏　秦　杰　杨　柳　安学锋　李国栋　马廉亭.颅内破裂动脉瘤合并脑内血肿的复合手术治疗[J].中国临床神经外科杂志,2016,(04):193-195.[doi:10.13798/j.issn.1009-153X.2016.04.001]
　WU Jie,YANG Ming,PAN Li,et al.Clinical observation of hybrid surgery on ruptured intracranial aneurysms associated with cerebral hematomas (report of 5 cases)[J].,2016,(04):193-195.[doi:10.13798/j.issn.1009-153X.2016.04.001]
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颅内破裂动脉瘤合并脑内血肿的复合手术治疗()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2016年04期
页码:
193-195
栏目:
论著
出版日期:
2016-04-25

文章信息/Info

Title:
Clinical observation of hybrid surgery on ruptured intracranial aneurysms associated with cerebral hematomas (report of 5 cases)
文章编号:
1009-153X（2016）04-0193-03
作者:
伍　杰　杨　铭　潘　力　蔡明俊　刘　鹏　秦　杰　杨　柳　安学锋　李国栋　马廉亭
430070 武汉，广州军区武汉总医院神经外科
通讯作者：杨　铭，E-mail：yangming3060@sina.com
Author(s):
WU Jie;  YANG Ming;  PAN Li;  CAI Ming-jun;  LIU Peng;  QIN Jie;  YANG Liu;  AN Xue-feng;  LI Guo-dong;  MA Lian-ting.
Department of Neurosurgery, Wuhan General Hospital, Guangzhou Command, PLA, Wuhan 430070, China
关键词:
颅内破裂动脉瘤; 脑内血肿; 复合手术; 疗效
Keywords:
Intracranial aneurysm;  Subarachnoid hemorrhage;  Intracranial hematoma;  Hybrid surgery
分类号:
R 743.9; R 651.1+2
DOI:
10.13798/j.issn.1009-153X.2016.04.001
文献标志码:
A
摘要:
目的 探讨复合手术治疗颅内破裂动脉瘤合并脑内血肿的疗效。方法 回顾性分析簧圈栓塞术后行颅骨钻孔血肿腔引流术治疗的5例颅内破裂动脉瘤合并脑内血肿的临床资料。结果 5例头颅CT均表现为典型蛛网膜下腔出血（SAH）合并脑内血肿；DSA发现动脉瘤位于大脑前动脉A2段分叉部1例、大脑前动脉A2段1例、前交通动脉1例、颈内动脉后交通动脉1例、大脑中动脉分叉部1例；术前Hunt-Hess分级Ⅱ级2例，Ⅲ级2例，Ⅳ级1例。引流术后3~4 d血肿大部分引流干净，无再出血、感染及脑梗死。术后6个月GOS评分3分1例，4分1例，5分3例。结论 对合并脑内血肿的自发性SAH，首先应考虑动脉瘤破裂出血可能，需尽早行DSA检查明确诊断；复合手术对于部分未发生脑疝又合并脑内血肿的破裂动脉瘤是可行的，能取得良好的疗效。
Abstract:
Objective To explore the curative effect of hybrid surgery on ruptured intracranial aneurysms associated with cerebral hematomas. Method The clinical data of 5 patients with ruptured intracranial aneurysms associated with cerebral hematomas treated by endovascular embolization combined with burr hole drainage were analyzed retrospectively. Results The CT showed that there was typical subarachnoid hemorrhage associated with cerebral hematomas in all the patients who were diagnosed as intracranial aneurysms by DSA including 1 aneurysm of the bifurcation of A2 segment of anterior cerebral artery, 1 aneurysm of A2 segment of anterior cerebral artery, 1 anterior communicating artery aneurysm, 1 posterior communicating artery aneurysm, and 1 aneurysm of the bifurcation of middle cerebral artery. The condition belonged in Hunt-Hess grade Ⅱ in 2 patients, grade Ⅲ in 2 and grade Ⅳ in 1. Most of the hematomas were successfully drained from 3 to 4 days after operation. There was no re-bleeding, infection or cerebral infarction during the hospital stay. The following up of 6 months after the operation showed that GOS scores were 3 in 1 patient, 4 in 1 and 5 in 3. Conclusions For spontaneous subarachnoid hemorrhage associated with intracranial hematomas, we should first consider the possibility of aneurysm rupture and DSA examination should be carried out as early as possible. Hybrid surgery is feasible for the patients with the ruptured aneurysms associated with intracranial hematomas but without cerebral hernia.

参考文献/References:

[1] Jeong JH, Koh JS, Kim EJ. A less invasive approach for rup- tured aneurysm with intracranial hematoma: coil emboliza- tion followed by clot evacuation [J]. Korean J Radiol, 2007, 8: 2-8.
[2] 马廉亭. 动脉瘤性蛛网膜下腔出血的诊治规范[J]. 中国现 代神经疾病杂志，2004，4：6-9.
[3] Takeuchi S, Takasato Y, Masaoka H, et al. Case of ruptured middle cerebral artery bifurcation aneurysm presenting as putaminal hemorrhage without subarachnoid hemorrhage [J]. Brain Nerve, 2009, 61(10): 1171-1175.
[4] Thai QA, Raza SM, Pradilla G, et al. Aneurysmal rupture without subarachnoid hemorrhage: case series and literature review [J]. Neurosurgery, 2005, 57(2): 225-229.
[5] Pasqualin A, Bazzan A, Cavazzani P, et al. Intracranial hematomas following aneurysmal rupture: experience with 309 cases [J]. Surg Neurol, 1986, 25: 6-17.
[6] Tokuda Y, Inagawa T, Katoh Y, et al. Intracerebral hema- toma in patients with ruptured cerebral aneurysms [J]. Surg Neurol, 1995, 43: 272-277.
[7] Otani N, Takasato Y, Masaoka H, et al. Surgical outcome following decompressive craniectomy for poor-grade aneu- rysmal subarachnoid hemorrhage in patients with associated massive intracerebral or Sylvian hematomas [J]. Cerebrovasc Dis, 2008, 26: 612-617.
[8] Shin YS, Kim SY, Kim SH, et al. Onestage embolization in patients with acutely ruptured poor-grade aneurysm [J]. Surg Neurol, 2005, 63: 149-155.
[9] Van LJ, Waerzeggers Y, Wilms G, et al. Early endovascular treatment of ruptured cerebral aneuryms in patients in very poor neurological condition [J]. Neurosurgery, 2002, 50: 457-465.
[10] Weir RU, Marcellus ML, Do HM, et al. Aneurysmal subara- chnoid hemorrhage in patients with Hunt and Hess grade 4 or 5: treatment using the Guglielmi detachable coil system [J]. Am J Neuroradiol, 2003, 24: 585-590.
[11] Niemann DB, Willis AD, Maartens NF, et al. Treatment of intracranial hematomas caused by aneurysm rupture: coil placement followed by clot evacuatiom [J]. J Neurosurg, 2003, 99: 843-847.
[12] Baltsavias GS, Byrne JV, Halsey J, et al. Effects of timing of coil embolization after aneurysmal subarachnoid hemorr- hage on procedural morbidity and outcomes [J]. Neurosur- gery, 2000, 47: 1329-1331.

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更新日期/Last Update: 2016-04-30