76例Hunt-Hess分级Ⅳ-Ⅴ级颅内动脉瘤破裂急性期的管理经验

【摘要】目的研究高级别颅内动脉瘤破裂急性期的治疗经验及疗效，并探讨最佳治疗方案。方法回顾性分析76例高级别颅内动脉瘤的临床资料，其中未处理动脉瘤的保守治疗38例（含脑室外引流7例，颅内血肿清除术1例），显微手术夹闭32例，介入栓塞6例。结果随访19个月（6~36个月），依据GOS评分，保守治疗组38例，预后良好1例（2.6%），重残1例（2.6%），预后极差36例（94.8%）；夹闭治疗组32例，良好7例（21.9%），极差16例（50%）；介入治疗6例，良好3例（50%），极差3例（50%）。结论高级别颅内动脉瘤超早期（<24 h）积极治疗较保守治疗可以明显改善预后。显微夹闭术后去骨瓣减压、脑室外引流等措施可以明显改善患者的预后。

Abstract： ObjectiveTo study the treatment experience and curative effect of acute rupture of high-grade intracranial aneurysms, and to explore the best treatment scheme. MethodsThe clinical data of 76 patients with high-grade intracranial aneurysms were analyzed retrospectively, including 38 cases of untreated aneurysms(including 7 cases of extraventricular drainage and 1 case of intracranial hematoma removal), 32 cases of microsurgical clipping and 6 cases of interventional embolization. ResultsThe patients were followed up for 19 months(6 ~ 36 months). According to the GOS score, of 38 cases in the conservative treatment group, 1 had a good prognosis(2.6%), 1 had severe disability(2.6%), and 36 had a very poor prognosis(94.8%). Of 32 cases in the clipping treatment group, 7 were good(21.9%) and 16 were very poor(50%). There were 6 cases of interventional therapy, 3 were good(50%) and 3 were very poor(50%). ConclusionsThe prognosis of high-grade intracranial aneurysms can be significantly improved by ultra early(< 24 h) active treatment than conservative treatment. Bone flap decompression and extraventricular drainage after clipping can significantly improve the prognosis of patients.