Endovascular Interventional Treatment Of Anterior Communicating Artery Aneurysms With Intracranial Hematoma

Objective:The treatment of anterior communicating artery aneurysms with intracranial hematoma is mainly microsurgery,and there are few reports of endovascular treatment.We collected the clinical data of patients with anterior communicating artery aneurysms with hematoma treated by endovascular interventional therapy in our hospital.summarize the experience and experience of endovascular interventional therapy,and explore its therapeutic effect and safety.Materials and methods:Retrospective analysis of the clinical data of 14 patients with ruptured anterior communicating artery aneurysms with intracranial hematoma who received endovascular interventional therapy from March 2013 to December 2018 in the Department of Neurosurgery of the First Affiliated Hospital of Soochow University,CT confirmed as subarachnoid hemorrhage,accompanied by intracranial hematoma,CTA or DSA confirmed as anterior communication aneurysm,statistics of patients admission symptoms,modified Fisher grade,Hunt-Hess grade,admission GCS score,hematoma location,hematoma volume,grade of aneurysm embolization,postoperative GCS score(first day),complications,hospitalization time,discharge Glasgow outcome scale(GOS)score,follow-up status.The GOS was used to evaluate the treatment effect of patients.A GOS score of 4-5 is a good prognosis,and a GOS score of 1-3 is a poor prognosis.Using SPSS21.0 statistical software to handle clinical for the data,the ?2 test of row × column list data was used to analyze the relationship between various factors and prognosis.P<0.05 was considered statistically significant.The paired sample t test was used to compare the preoperative GCS score and the postoperative GCS score(first day)to analyze the effect of intravascular embolization treatment.P<0.05 was considered statistically significantResluts:In this group,including 8 males 6 female patients,headache in 3 cases,epilepsy in 2 cases,confusion in 9 cases.1 case in Hunt-Hess 1,4 cases of grade ?,7 cases of grade ?,2 cases of grade V;admission GCS score:15 in 1 case,9-11 in 4 cases,?8 in 9 cases;postoperative GCS score(first day)was 15 in 1 case,12-14 in 3 cases,9-11 in 3 cases and?8 in 7 cases.At discharge,GOS score was 5 in 6 cases,4 in 3 cases,3 in 3 cases,and 1 in 2 cases.In Hunt-Hess ?-? patients,the good prognosis rate was 100%(5/5),and in Hunt-Hess ?-? patients,the good prognosis rate was 44.4%(4/9).When the hematoma volume is less than 15ml,the good prognosis rate of the patient is 75%(9/12).Intraoperative DSA confirmed that the incidence of cerebral vasospasm was 42.9%(6/14).The good prognosis rate was 64.3%;follow-up for 6-12 months,DSA follow-up in 5 cases,no recurrence of aneurysms,telephone follow-up in 7 cases,the state of consciousness was better than before.The above factors are statistically different from the prognosis of patients(P<0.05).Preoperative GCS score and postoperative GCS score(first day)were compared,the results showed statistical significance(P<0.05).Among the various influencing factors,age,gender,hydrocephalus,intraventricular hemorrhage,cerebral vasospasm,tumor neck width,tumor size,hematoma location and tumor orientation were not statistically different from the patient's prognosis(P>0.05).Conclusion:1.The condition of patients with anterior communicating artery aneurysm with intracranial hematoma is serious,and endovascular embolization is safe and effective.2.The prognosis of the patients was related to Hunt-Hess grade,and hematoma volume before operation.