中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2009年
2期
117-120
,共4页
梁玉敏%潘耀华%万杰清%殷玉华%包映晖%高国一%熊文浩%徐纪文%罗其中%江基尧
樑玉敏%潘耀華%萬傑清%慇玉華%包映暉%高國一%熊文浩%徐紀文%囉其中%江基堯
량옥민%반요화%만걸청%은옥화%포영휘%고국일%웅문호%서기문%라기중%강기요
脑动脉瘤%脑出血%蛛网膜下腔出血
腦動脈瘤%腦齣血%蛛網膜下腔齣血
뇌동맥류%뇌출혈%주망막하강출혈
Cerebral aneurysm%Cerebral hemorrhage%Subarachnoid hemorrhage
目的 总结无蛛网膜下腔出血(SAH)的破裂脑动脉瘤的诊治经验.方法 对15例在起病后2 d内首次CT或MRI上表现为脑内出血(ICH),和(或)脑室内出血(IVH)、硬脑膜下血肿(SDH)和壁间出血(IMH)而无SAH的破裂脑动脉瘤患者的临床表现、影像学检查结果 、治疗方法 和预后进行回顾性分析.结果 本组首次CT或MRI检查表现为ICH者3例、IVH合并ICH者6例、SDH者1例、IVH者1例、IMH者3例和等高混合密度者1例.其中动脉瘤位于大脑中动脉6例、前交通动脉4例、后交通动脉3例、大脑前动脉1例和小脑后下动脉1例.开颅手术夹闭动脉瘤13例,血管内栓塞2例.出院时GOS评分:恢复良好8例、中残3例、重残3例和植物生存1例.本组15例占同期破裂脑动脉瘤的3.8%.结论 破裂脑动脉瘤首次CT扫描可表现为单纯ICH,和(或)IVH、SDH、IMH而无SAH,与CT扫描时间、动脉瘤的部位和指向以及出血量有关.早期控制颅内高压、及时诊断和有效处理破裂动脉瘤,是改善预后的关键.
目的 總結無蛛網膜下腔齣血(SAH)的破裂腦動脈瘤的診治經驗.方法 對15例在起病後2 d內首次CT或MRI上錶現為腦內齣血(ICH),和(或)腦室內齣血(IVH)、硬腦膜下血腫(SDH)和壁間齣血(IMH)而無SAH的破裂腦動脈瘤患者的臨床錶現、影像學檢查結果 、治療方法 和預後進行迴顧性分析.結果 本組首次CT或MRI檢查錶現為ICH者3例、IVH閤併ICH者6例、SDH者1例、IVH者1例、IMH者3例和等高混閤密度者1例.其中動脈瘤位于大腦中動脈6例、前交通動脈4例、後交通動脈3例、大腦前動脈1例和小腦後下動脈1例.開顱手術夾閉動脈瘤13例,血管內栓塞2例.齣院時GOS評分:恢複良好8例、中殘3例、重殘3例和植物生存1例.本組15例佔同期破裂腦動脈瘤的3.8%.結論 破裂腦動脈瘤首次CT掃描可錶現為單純ICH,和(或)IVH、SDH、IMH而無SAH,與CT掃描時間、動脈瘤的部位和指嚮以及齣血量有關.早期控製顱內高壓、及時診斷和有效處理破裂動脈瘤,是改善預後的關鍵.
목적 총결무주망막하강출혈(SAH)적파렬뇌동맥류적진치경험.방법 대15례재기병후2 d내수차CT혹MRI상표현위뇌내출혈(ICH),화(혹)뇌실내출혈(IVH)、경뇌막하혈종(SDH)화벽간출혈(IMH)이무SAH적파렬뇌동맥류환자적림상표현、영상학검사결과 、치료방법 화예후진행회고성분석.결과 본조수차CT혹MRI검사표현위ICH자3례、IVH합병ICH자6례、SDH자1례、IVH자1례、IMH자3례화등고혼합밀도자1례.기중동맥류위우대뇌중동맥6례、전교통동맥4례、후교통동맥3례、대뇌전동맥1례화소뇌후하동맥1례.개로수술협폐동맥류13례,혈관내전새2례.출원시GOS평분:회복량호8례、중잔3례、중잔3례화식물생존1례.본조15례점동기파렬뇌동맥류적3.8%.결론 파렬뇌동맥류수차CT소묘가표현위단순ICH,화(혹)IVH、SDH、IMH이무SAH,여CT소묘시간、동맥류적부위화지향이급출혈량유관.조기공제로내고압、급시진단화유효처리파렬동맥류,시개선예후적관건.
Objective To summarize the experiences of diagnosis and treatment of ruptured cerebral aneurysm without subarachnoid hemorrhage(SAH). Methods The clinical manifestations, neuroradiological results, methods of treatment and outcome of 15 cases of ruptured cerebral anenrysm which presented with intracerebral hemorrhage (ICH), and/or intraventricular hemorrhage (IVH), subdural hematoma (SDH) or intramural hemorrhage(IMH) without SAH on initial CT or MRI were reviewed retrospectively. Results The initial CT or MRI in 15 cases was obtained within 2 days after onset. Of these cases, three patients presented with ICH, six with ICH and IVH, one with IVH, one with SDH, three with IMH and 1 with mixed density. There are six middle cerebral artery, four anterior communicating artery, three posterior communicating artery, one anterior cerebral artery and one posterior inferior cerebellar artery aneurysms. Thirteen patients underwent a craniotomy for clipping and two patients endovascular coiling. According Glasgow Outcome Scale (GOS),8 patients recovered well, 3 became moderately disabled, 3 were severely disabled and 1 was in vegetative state on discharge. The incidence of aneurysm rupture with ICH and/or IVH, SDH, IMH without SAH is 3.8% in this report. Conclusions Initial CT or MRI of ruptured cerebral aneurysms may presented with ICH, and/or IVH, SDH and IMH without SAH, which may have a muhifactorial cause attributable to the timing of CT or MRI, location of the aneurysm and direction of its dome, and the amount of hemorrhage. The key points to improve the outcome of such cases are to control increased intracranial pressure earlier, diagnose and manage ruptured aneurysms promptly.
