Diagnosis and treatment of patients with middle cerebral artery aneurysms combined with intra-Sylvian hematomas

( views:377, downloads:0 )
Author:
SONG Chao-yan(Department of Neurosurgery, First Hospital of Baoding, Baoding 071000, China)
SUN Zheng-hui()
XV Bai-nan()
WU Chen()
XUE Zhe()
MA Hong-wei()
Journal Title:
Chinese Journal of Neuromedicine
Issue:
Volume 11, Issue 09, 2012
DOI:
10.3760/cma.j.issn.1671-8925.2012.09.010
Key Word:
Middle cerebral artery;Aneurysm;Intra-Sylvian hematoma;Intraoperative monitoring;Microsurgical management

Abstract: Objective To summarize the diagnosis and treatment experience of patients with middle cerebral artery aneurysms (MCAAs) associated with intra-Sylvian hematomas. Methods The clinical data of 21 patients with ruptured MCAAs associated with intra-Sylvian hematomas (haemorrhage ≥20mL), admitted to our hospital from November 2006 to May 2011, were analyzed retrospectively. Treatment experiences of MCAAs associated with intra-Sylvian hematomas with microsurgery were concluded. Results Among them,12 patients were performed clipping and 8 were performed resection and clipping. Bypass of superficial temporal artery to middle cerebral artery was performed before occlusion of the afferent artery in 1 patient.When the patients discharged from hospital,their Glasgow outcome scale (GOS) were 4-5 scores in 16 patients,3 scores in 3,2 scores in 1 and 1 score in 1; excellent outcomes were achieved in 15 patients, no marked changes in 4 patients, and post-operative complications were observed in 1 patient; 1 perioperative death occurred. Conclusion Ruptured MCAAs combined with intra-Sylvian hematomas should be differed from hypertension hemorrhage of basal ganglia areas; intraoperative Doppler sonography,introperative indocyanine green angiography and neurophysiological monitoring are helpful during the surgical treatment.

  • [1]Dashti R,Hernesniemi J,Niemela M,et al.Microneurosurgical management of middle cerebral artery bifurcation aneurysms[J].Surgical Neurology,2007(67):441-456.
  • [2]Matsumoto M,kasuya H,Sato T,et al.Can 3D-CT angiography (3D-CTA) replace conventional catheter angiography in ruptured aneurysm surgery? Our experience with 162 cases[J].Fukushima J Med Sci,2007,53(2):85-94.
  • [3]Dashti R,Hemesniemi J,Lehto H,et al.Microneurosurgical management of proximal anterior cerebral artery aneurysms[J].Surg Neurol,2007,68(4):366-377.
  • [4]刘永哲,高明龙,潘宁玲.过度通气对控制性降压下颅内动脉瘤夹闭术中脑氧代谢的影响[J].实用医学杂志,2011,27 (11):1962-1964.
  • [5]Yonekawa Y, Khan N, Imhof HG, et al. Basilar bifurcationaneurysms.Lessons learm from 40 eozrsecutive cases[J].ActaNeurochir Suppl.2005,94:39-44.
  • [6]许百男,孙正辉,姜金利,等.搭桥血管重建技术在颅内复杂动脉瘤治疗中的应用[J].中华神经外科杂志,2009,25(1):19-22.
  • [7]姜燕,卜博,许百男,等.颅内动脉瘤术中阻断载瘤动脉后脑供血状态的神经电生理监测[J].中国脑血管病杂志,2009,6(11):577-580.
  • [8]王芙昱,许百男,姜燕,等.手术中微血管多普勒超声在颅内巨大动脉瘤治疗中的应用[J].中华老年心脑血管病杂志,2008,10(5):350-352.
  • [9]王建涛,左峰,王硕.吲哚菁绿造影在巨大动脉瘤手术中的应用[J].中华神经医学杂志,2010,9(12):1234-1237.
  • [10]Collice M,D'Alibert G,Talamonti G.Current indications for aneurysm surgery[J].Neuroimaging Clin N Am,2006,16(3):497-512.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615 Email:yiyao@wanfangdata.com.cn