Microsurgical Treatment Of Intracranial Aneurysms

Objective To probe the optimal technique of microsurgery for early hemorrhage from intracranial aneurysms, investigate the time of operation, the therapeutic effect, and summarize the treating method for cerebral vasospasm after operation.Methods The bata of 41 cases of intracranial aneurysm , who were admitted to our hospital from 2004 to 2006, were retrospectively analyzed. Of these patients, 26 cases were male and 15 cases were female. The patient age ranged from 9 to 67 years(mean 48.3 years). 1 case was unruptured intracranial aneurysms with onset of blepharoptosis. 40 cases had definte subarachnoid hemorrhage in which 36 cases suffered primary hemorrhage; 4 cases suffered twice- hemorrhage. All patients were classed by Hunt-Hess:grade I (n =9),gradeII(n=18), gradeIII(n=11), gradeIV(n=3). All cases were confirmed with spontaneous subarachnoid hemorrhage by head CT or MRI scanner before hospitalization. Among them, 31 cases showed intracerebral hematoma in ante-diastematia and frontal lobe, in which 8 cases ruptured into the cerebral ventricle. 10 cases had hemorrhage in temporal lobe, in which 2 cases ruptured into the cerebral ventricle. All cases were diagosed definitely as intracranial aneurysms confirmed by DSA(29 cases), CTA(8 cases) and MRI(4 cases). Among them, 13 cases showed anterior communicating artery aneurysms, 5 cases showed anterior cerebral artery aneurysms, 13 cases showed internal carotid artery aneurysms, 3 cases showed middle cerebral artery aneurysm, 5 cases showed internal carotid-posterior communicating artery aneurysms, 1 cases showed posterior cerebral artery aneurysm, 1 cases showed posterior inferior cerebellar artery aneurysm. 1 case with unruptured intracranial aneurysms received selective operation. Of those patients with primary hemorrhage, 5 cases were operated within 12h, 14 cases within 24h, 9 cases within 48h and 8 cases within 72h. Of those patients with second hemorrhage, 3 cases were operated within 12h and one case within 24h. Modified Yasargil's approach, subtemporal approach or suboccipital approach were adopted for the most patients. All procedures of the surgery and placing aneurysm clips were performed under the operative microscope.Results 41 cases were completely clipped by aneurysm clips. After clipped, 3 cases showed hemiplegia and aphasia because of cerebral vasospasm and cerebral infarction, one case showed psychiatric symptom. 5 cases showed oculomotor palsy, of which, the symptom of 4 cases was disappeared after 6 months. One case with middle cerebral artery aneurysm that showed rerupture bleeding 14 days after the first surgery received resurgery to place aneurysm clip. In the 3 to 12-month follow-up, 35 cases recovered well, 4 cases got in a mild disability and 2 cases in severe disability in, no death in all the 41 cases.Conclusion Head CT scanner is the first selected mean to diagnose spontaneous subarachnoid hemorrhage, while DSA is the most valuable mean to diagnose intracranial aneurysm. Early surgery clipped not only can avoid the rebleeding of aneurysm, but also can remove blood clots and bloody cerebrospinal fluid at subarachnoid cavity, relieve or eliminate cerebral vasospasm. Some patients who received delayed operation may die from the rehemorrhage thus lost the chance of treatment. Aneurysmal clipping surgery requires that the surgeon has the proficient microsurgical technique because the operation has some problems including great difficult and high technical requirements. Skillful microsurgery technique raised the successful rate of operation. Patients at or below Hunt-Hess grade III showed good effects after operation, those at or above Hunt-Hess grade IV showed higher disabling rate. We should strengthen the prevention and treatment of the complications, reduce the disabling rate and mortality rate, and improve the quality of life of the patients.