脑动脉瘤破裂伴发急性硬膜下血肿的诊治

目的 探讨脑动脉瘤(AN)破裂所致的急性硬膜下血肿(ASDH)的临床、影像学特点和诊治方案。方法 回顾288例破裂AN，发现10例伴有ASDH。Huni Hess分级，Ⅱ级3人，Ⅲ级1人，Ⅳ级3人，Ⅴ级3人，均经CTA诊断为AN破裂，除2例外均被脑血管造影或手术所证实。保守治疗2例，血肿清除加AN夹闭术4例，电解脱弹簧圈(GDC)栓塞后加血肿清除2例，栓塞加脑室外引流1例，单纯栓塞l例。结果 疗效优者2例，中残者l例，7例死亡。结论 AN性ASDH的预后极差，同术前分级相关；CTA检查后立即行血肿清除加动脉瘤夹闭有助于提高预后，合适患者可联合栓塞和血肿清除术。

The diagnosis and teatment of acute subdural hematoma secondary to ruptured cerebral aneurysm

Objective To investigate the clinical features, diagnosis, and treatment of acute subdural hematoma (ASDH) from ruptured cerebral aneurysm. Methods Among 288 patients with ruptured aneurysms, 10 patients presented ASDH secondary to ruptured aneurysms. The Hunt & Hess grade of the patients on admission was grade 2 ( n - 3 ) , grade 3 ( n = 1) , grade 4 ( n = 3 ) , and grade 5 ( n = 3 ) . All patients received computed tomography angio-graphy(CTA) which revealed ruptured aneurysms. The diagnosis of aneurysm from CTAs was verified by DSA or operations except two. Two patients were treated conservatively, 4 underwent both hematoma evacuation and aneurysms clipping, 2 received GDC embolization followed by hematoma evacuation, 1 received GDC embolization followed by external ventricular drainage and 1 underwent GDC embolization alone. Results The outcome was good recovery in 2 patients, moderately disabilited in 1 patient, and dead in 7 patients. Conclusion The outcome of the patients with aneurysmal ASDH was very poor. Its prognosis was consistent with preoperative Hunt & Hess grade. CTA followed by emergent hematoma evacuation and aneurysm clipping may improve the prognosis. Combined embolization and operation may be suitable to some selected patients.