显微手术夹闭颅内动脉瘤手术疗效分析

目的：探讨显微手术夹闭颅内动脉瘤手术的疗效。方法：回顾性分析自2005年10月至2010年10月期间开颅行夹闭颅内动脉瘤手术的39例患者的临床资料。结果：除有1例死亡外,其中29例恢复良好,能生活自理,7例伴有轻度残疾,需人照顾,2例重残,需要卧床。结论：夹闭颅内动脉瘤手术获得了较好的疗效,我们发现避开血管痉挛发生的高峰期即可达到较好的疗效,即在3日内或14日后实行手术较为适宜。     

早期介入微弹簧圈栓塞治疗脑动脉瘤破裂的疗效及预后分析

目的:研究分析早期介入微弹簧圈栓塞治疗脑动脉瘤破裂的疗效及预后。方法:选取我院2011年至2014年期间收治的脑动脉瘤破裂患者96例作为研究对象。根据数字法随机分成观察组及对照组各48例,观察组患者在入院3d之内实施微弹簧圈栓塞形式介入治疗,对照组治疗时间为入院3 d后。对比两组患者临床治疗疗效、并发症发生情况、以及术后6个月的改良Rankin量表(m RS)、改良型日常生活能力(MBI)评分。结果:观察组的栓塞效果显著好于对照组,差异有统计学意义(P0.05)。观察组术后6个月的m RS评分显著低于对照组,且MBI评分显著高于对照组,差异均有统计学意义(均P0.05)。观察组的并发症发生率均显著低于对照组,差异均有统计学意义(均P0.05)。结论:入院3d之内利用微弹簧圈栓塞对脑动脉瘤破裂实施早期介入治疗,具有较好的疗效及预后,值得临床重视。     

不同手术时机治疗颅内前循环动脉瘤破裂疗效及预后分析

目的:比较不同手术时机治疗颅内前循环动脉瘤破裂患者的疗效及对患者远期预后的影响。方法:回顾性分析我院2010年3月~2015年10月收治的120例颅内前循环动脉瘤破裂患者的临床资料,所有患者均接受显微手术夹闭治疗,按手术时机分为超早期组(24 h,n=43)、早期组(24-72 h,n=36)、延期组(≥10 d,n=41),比较各组术后颅内动脉栓塞改善程度,统计各组术中及术后并发症发生情况,采用格拉斯哥量表(GOC)评定患者术后恢复情况,采用改良Rankin(m RS)表评定患者远期预后。结果:超早期组完全栓塞率略高于早期组、延期组,但对比差异无统计学意义(P0.05);超早期组术中、术后各并发症发生率略低于早期组、延期组,但对比差异无统计学意义(P0.05);术后6、12、24个月,超早期组、延期组GOS评分高于早期组、m RS评分低于早期组,超早期组GOS评分高于延期组,m RS评分低于延期组(P0.05)。结论:不同手术时机治疗颅内前循环动脉瘤破裂手术效果无明显差异,但超早期、延期手术患者术后恢复及预后评分稍优于早期手术。     

经翼点入路显微手术治疗后交通动脉瘤

目的：探讨显微手术治疗后交通动脉瘤的手术时机,避免术后脑积水的手段及双侧后交通动脉瘤的处理方法。方法：采用翼点入路,早期显微手术夹闭后交通动脉瘤41例,两例双侧后交通动脉瘤患者成功采用一侧翼点入路夹闭双侧动脉瘤。结果：本组41例动脉瘤均顺利夹闭,28例患者术前存在动眼神经麻痹,27例术后症状消失或者缓解,1例未有明显改善。41例患者均行终板造瘘,术后出现脑积水患者1例。无死亡病例。随访1～10月无动脉瘤残留及复发。结论：早期手术夹闭后交通动脉瘤有利于动眼神经麻痹的恢复,术中行终板造瘘可降低术后脑积水的发生,对侧后交通动脉瘤的指向、位置及后交通动脉与颈内动脉的解剖关系是影响一侧入路夹闭双侧后交通动脉瘤的关键因素。     

小脑后下动脉瘤经微血管多普勒超声辅助下的显微外科治疗

目的：探讨小脑后下动脉瘤（PICA）的微血管多普勒超声（MVD）辅助下显微外科治疗。方法：回顾性分析31例患者的显微外科手术的临床症状,影像特点,外科治疗方法及相关预后。结果：头颅CT表现主要为幕下为主的蛛网膜下腔出血或脑室出血或二者兼有（除1例未破裂）。其中经全脑数控减影血管造影术（DSA）和/或CT血管造影（CTA）检查确诊。其中手术路径为枕下旁正中16例,枕下正中入路14例,枕下乙状窦后入路1例。在MVD的辅助下行脉瘤夹闭术27例,动脉瘤包裹术1例,动脉瘤夹闭并动静脉畸形切除术2例,动脉瘤夹闭术并小脑血肿清除术1例。术后出现并发症10例,其中3例意识障碍致死亡或自动出院,其余患者术后无神经功能损伤或并发症,恢复良好。结论：小脑后下动脉瘤的治疗选择合适的手术入路行显微外科手术,辅助MVD下,能够降低手术风险,提高完全夹闭动脉瘤的成功率,降低手术并发症的发生。     

股动脉假性动脉瘤形成并破裂出血的院前急救

目的 探讨股动脉假性动脉瘤形成并破裂出血的院前急救措施.方法 回顾性分析16例股动脉假性动脉瘤形成并破裂出血患者的院前救治,如现场加压包扎止血、快速补充血容量、安全转运、与院内急救无缝衔接及个人防护等.结果 16例患者均经静脉吸毒,其中明确HIV感染11例,除2例现场抢救无效死亡外,余14例均能有效止血,血压回升,及时、安全转送到外科病房,其中5例患者直接进行手术治疗,14例患者均好转出院;医务人员无职业暴露发生.结论 采取序贯有效的综合处置措施,是对股动脉假性动脉瘤并破裂出血患者院前急救成功的关键;熟练掌握院前急救止血等技术,注重个人职业暴露的防护,能降低职业暴露的风险,最大限度地保证医患双方安全.     

血管内栓塞治疗已破裂后交通动脉瘤的临床研究

目的:探讨已破裂后交通动脉瘤的血管内栓塞介入治疗的临床疗效.方法:对73例血管内介入栓塞治疗已破裂后交通动脉瘤患者资料回顾分析,观察临床治疗效果.结果:所有患者均成功栓塞,获100％栓塞35个(47.9％),95％栓塞24个(32.9％),90％栓塞13个(17.8％),80％栓塞1个(1.4％),发生并发症6例(8.2％),术后随访未见复发病例(0.0％).结论:已破裂后交通动脉的血管内介入栓塞治疗是一种微创、安全、有效的方法.     

Willis环状脑动脉瘤生物数学模型的渐近解

一、引言 G. Austin在1971年制作了模拟脑动脉瘤的物理装置实验,用一个模拟电路来描述动脉瘤内血液的流动状态,得出了一个数学模型。文[2]对文[1]的模拟电路再进行分析,归结出较文[1]完善的数学模型,是下列具阻尼项及外激励的三次非线性的Duffing方程     

Willis环状脑动脉瘤的生物数学模型的周期解

本文运用扭转映射的不动点定理,通过Poincare'映射,在(μ/2)+((β~2)/(4a))<1的条件下,证明了Willis环状脑动脉瘤生物数学模型 +μ+αx-βx~2+γx~3=Fcosωt(其中μ,α,β,γ,F,ω都是正常数)至少存在一个(2π)/ω周期解。     

颅内动脉瘤手术的麻醉处理

目的:对40例颅内动脉瘤手术的麻醉处理进行回顾.方法:诱导插管后施行丙泊酚和异氟醚静吸复合全麻,术中应用压宁定、尼莫地平或异氟醚施行控制性降压,用Ohmedar麻醉机施行控制呼吸.结果:诱导后HR和MAP有显著性降低,但在正常范围内;维持期MAP略有下降,但MAP平均值仍维持在(13.8±1.50)kPa,其他指标SpO2、PETCO2、ECG等均无大变化.结论:颅内动脉瘤夹闭术的麻醉诱导及维持要求平顺稳定,术中需施行控制性降压以避免脑动脉瘤破裂并减少出血.     

Management and Surgical Treatment of Ruptured Intracranial Aneurysms

The advantages, methods and results of surgical intracranial obliteration of aneurysms in conjunction with the use of intracranial or neck ligation of arteries were studied in 177 patients made up of the following groups: (a) internal carotid aneurysms-48, (b) anterior cerebral-anterior communicating-37, (c) middle cerebral-20, (b) basilar-two, (e) posterior cerebral-one. The overall mortality rate was 23%. Following conservative treatment, 69 patients with subarachnoid hemorrhage without demonstrated aneurysms had a mortality rate of 30%. In this seven-year study the value of team work involving a second neurosurgeon, well-trained nursing personnel and expert anesthetists was amply demonstrated.     

Intracranial Aneurysms

A reappraisal of case histories of patients with ruptured intracranial aneurysms emphasized the importance of clinically recognizing severe spasm that contraindicates early angiography and large cerebral haematomas that require immediate evacuation. Observation from the day of haemorrhage is important; most recurrent episodes with cerebral signs in the first 10 days were due to spasm; haemorrhage was more common during the following two weeks. In many attacks the signs were not sufficiently distinctive for diagnosis of spasm or haematoma.     

The Genetics of Primary Haemorrhagic Stroke,Subarachnoid Haemorrhage and Ruptured Intracranial Aneurysms in Adults

Background

The genetic basis of haemorrhagic stroke has proved difficult to unravel, partly hampered by the small numbers of subjects in any single study. A meta-analysis of all candidate gene association studies of haemorrhagic stroke (including ruptured subarachnoid haemorrhage and amyloid angiopathy-related haemorrhage) was performed, allowing more reliable estimates of risk.

Methods

A systematic review and meta-analysis of all genetic studies in haemorrhagic stroke was conducted. Electronic databases were searched until and including March 2007 for any candidate gene in haemorrhagic stroke. Odds ratio (OR) and 95% confidence intervals (CI) were determined for each gene disease association using fixed and random effect models.

Results

Our meta-analyses included 6,359 cases and 13,805 controls derived from 55 case-control studies, which included 12 genes (13 polymorphisms). Statistically significant associations with haemorrhagic stroke were identified for those homozygous for the ACE/I allele (OR, 1.48; 95% CI, 1.20–1.83; p = 0.0003) and for the 5G allele in the SERPINE1 4G/5G polymorphism (OR, 1.42; 95% CI, 1.03–1.96; p = 0.03). In addition, both &b.epsi;2 and &b.epsi;4 alleles of APOE were significantly associated with lobar haemorrhage (OR, 1.81; 95% CI, 1.26–2.62; p = 0.002 and OR, 1.49; 95% 1.08–2.05; p = 0.01 respectively). Furthermore, a significant protective association against haemorrhagic stroke was found for the factor V Leiden mutation (OR, 0.30; 95% CI, 0.10–0.87; p = 0.03).

Conclusion

Our data suggests a genetic contribution to some types of haemorrhagic stroke, with no overall responsible single gene but rather supporting a polygenic aetiology . However, the evidence base is smaller compared to ischaemic stroke. Importantly, for several alleles previously found to be associated with protection from ischaemic stroke, there was a trend towards an increased risk of haemorrhagic stroke.     

Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms

Less invasive surgical approaches for intracranial aneurysm clipping may reduce length of hospital stay, surgical morbidity, treatment cost, and improve patient outcomes. We present our experience with a minimally invasive pterional approach for anterior circulation aneurysms performed in a major tertiary cerebrovascular center and compare the results with an aged matched dataset from the Nationwide Inpatient Sample (NIS). From August 2008 to December 2012, 22 elective aneurysm clippings on patients ≤55 years of age were performed by the same dual fellowship-trained cerebrovascular/endovascular neurosurgeon. One patient (4.5%) experienced transient post-operative complications. 18 of 22 patients returned for follow-up imaging and there were no recurrences through an average duration of 22 months. A search in the NIS database from 2008 to 2010, also for patients aged ≤55 years of age, yielded 1,341 hospitalizations for surgical clip ligation of unruptured cerebral aneurysms. Inpatient length of stay and hospital charges at our institution using the minimally invasive thumb-sized pterional technique were nearly half that of NIS (length of stay: 3.2 vs 5.7 days; hospital charges: $52,779 vs. $101,882). The minimally invasive thumb-sized pterional craniotomy allows good exposure of unruptured small and medium-sized supraclinoid anterior circulation aneurysms. Cerebrospinal fluid drainage from key subarachnoid cisterns and constant bimanual microsurgical techniques avoid the need for retractors which can cause contusions, localized venous infarctions, and post-operative cerebral edema at the retractor sites. Utilizing this set of techniques has afforded our patients with a shorter hospital stay at a lower cost compared to the national average.     

颅内动脉瘤栓塞术的临床分析

目的：用动脉瘤栓塞体积比评价颅内动脉瘤栓基术的治疗效果,观察颅内动脉瘤栓塞术治疗颅内动脉瘤的影响因素及颅内动脉瘤栓塞术的术后情况。方法：选取112例行血管内栓塞治疗的患者为研究对象,按术后动脉瘤栓塞体积比分成VER〉25％和VER〈25％两组,观察不同的栓塞材料（电解可脱弹簧圈、水解可脱弹簧圈）和术中血管的痉挛程度（轻、中、重）对栓塞程度的影响;术后随访106例病人,按动脉瘤栓塞体积比分成VER〉25％和VER〈25％两组,统计两组患者的再出血率和复发率,用动脉瘤栓塞体积比评价栓塞术的预后效果。结果：动脉瘤栓塞体积比VER〉25％和VER〈25％两组间进行比较,不同血管痉挛情况下和使用不同的栓塞材料在两组间均存在显著差异（P〈O．05）,具有统计学意义;术后随访半年,比较VER〉25％和VER〈25％两组的再出血率也有显著差异（P〈O．05）,具有统计学意义。结论：动脉瘤栓塞体积比在评价颅内动脉瘤栓塞术中有重要意义,血管痉挛情况、栓塞材料是影响颅内动脉瘤栓塞术栓塞疗效的主要影响因素;术后随访证实动脉瘤栓塞体积比对评价动脉瘤栓塞术的预后有一定的作用。