39例动脉瘤性蛛网膜下腔出血介入结合术后微创综合治疗体会

目的探讨动脉瘤性蛛网膜下腔出血（SAH）神经介入栓塞结合术后微创方法综合治疗的临床疗效。 方法2010年11月～2012年12月39例自发性SAH患者，均在DSA确诊为动脉瘤后，先行神经介入栓塞术栓塞动脉瘤，之后根据病情及CT表现选择性行脑室外引流、腰大池置管引流及腰穿置换引流中的一种或多种微创方法治疗。 结果术后严重血管痉挛致死亡患者1例，无重度残疾发生，中度残疾1例，轻度残疾2例，其余35例均恢复良好，其中2例因脑积水最终行脑室-腹腔分流术，术后恢复良好；术后随诊，1年后27例患者来院复查DSA，其中2例动脉瘤复发，均行二次栓塞，恢复良好，其余24例患者未见复发，也未见脑积水、血管痉挛等并发症；全部病例未再出血。 结论神经介入栓塞术结合术后微创方法治疗动脉瘤性蛛网膜下腔出血效果良好，可降低并发症的发生率。

Thirty-nine cases of aneurysmal subarachnoid hemorrhage neural interventional therapy and minimally invasive treatment experience

ObjectiveTo explore the clinical efficacy of interventional therapy combined with minimally invasive treatment of aneurysmal subarachnoid hemorrhage. MethodsThirty-nine patients with spontaneous subarachnoid hemorrhage patients were diagnosed with aneurysm in the DSA. Firstly embolization of aneurysmwas done, then according to state of disease and CT performance, one or more minimally invasive treatment method such as external ventricular drainage, lumbar drainage of fluid and replacement of lumbar puncture drainage were chosen. ResultsOne patient died of severe vasospasm after operation. There was no severe disability, 1 patient with moderate disability, 2 with mild disability, the other 35 patients recovered well in which 2 cases with hydrocephalus underwent ventriculo-peritoneal shunt, good recovery after surgery. One-year follow-up after surgery, 27 patients came to review DSA, including 2 cases with aneurysm relapse growing received second embolization and had good recovery. The remaining 24 patients did not relapse, hydrocephalus, vasospasm and other complications were not found. All cases were not rebleeding. ConclusionsNerve embolization combined with postoperative minimally invasive approach in treatment of aneurysmal subarachnoid hemorrhage have good effect, could reduce the incidence rate of complications.