顱內(nèi)動脈瘤的診斷及治療講課用

顱內(nèi)動脈瘤的診斷及治療Intracranialaneurysmdiagnosisandtherapy蘇州大學附屬第一醫(yī)院神經(jīng)外科王晶EpidemiologyMorbility:6～35.3/100thousandsarea：Lowest：India、theMiddleEast、China

1～2/100thousandsHighest：Finland、Japan、Scotland26.4～96.1/100thousandsF:M1.3～1.6:1。Commonage:40-60years，about2/3。LinnFH,RinkelGJ,AlgraA,vanGijnJ.Incidenceofsubarachnoidhemorrhage:roleofregion,year,andrateofcomputedtomography:ameta-analysis.Stroke.1996Apr;27(4):625-9.Aneurysmetiology1、Congenital80%～90%2、Arteriosclerosis10%～18%3、Infective0.5%～2.0%4、Traumatic0.5%Riskfactors1、Age2、heredity3、bloodflowdynamic4、Defectsinthearterialwallofthemiddle5、Aneurysmscoexistwithothercongenitalanomalies6、HypertensionAneurysmclassificationsize：1.S：＜0.5cm；2.M：0.5-1.4cm；3.L：1.5-2.4cm；4.H：≥2.5cmAneurysmclassification

shape：1、capsular2、intervallum3、FusiformanteriorofWillisarterialcircle>80%internalcarotidarteryICA 30%anteriorcerebralartery ACA30%middlecerebralartery MCA20%vertebralarteryandbasilararteryVA&BA 5%others 15%Aneurysmclassification

commonposition:

Aneurysmclassification

position:

Rhoton,AlbertL.Neurosurgery.51(4),October2002

0Locations

ofaneurysmrupture

Top64%Middle10%Neck2%unclear

24%Top-ruptureClinicalpresentationofintracranialaneurysm

non-rupture

1、Noclinicalsymptoms,physicalexaminationwhentheaccidentaldiscovery

2、IntracranialpressuresymptomsClinicalpresentationofaneurysmrupture

meningealirritativesign:Headache,vomit,neckrigidityhemiplegiaaphemia EpilepsyunconsciousnessIntracerebralhematomaCommunicate-hydrocephalusCerebralvasopasm

Hunt&HessgradingHunt&Hess（1968）（1974）Ⅰ

NoSymptomorheadache,neckrigidityⅡcerebralNpalsy(Ⅲ,Ⅳ)Moderatetosevereheadache,neckrigidityⅢDrowsinessorconfusionMildneurologicaldeficitsⅣComa,inmoderatetoseverehemiplegiaEarlydecerebraterigidityⅤDeepcoma,decerebraterigidity,moribundExamination&Diagnosis1、Lumbarpuncture:caution!2、CT&CTA3、MRI&MRA4、DSALumbarpunctureCTCTA（3D-animation)CTA（modellingsurgicalapproach)CTA（showtheclipafterop)MRI&MRAMRADSADSA:L-OphAANCTA:nagetive

DSA:L-PICAANCTA:L-PcoAANDSA:L-PcoAShadow

DSA:nagetive

CTA:R-PcoAAN&R-OphAANTreatmentHemorrhageCerebralVasospasmHydrocephalusRestinbedDrugsOpORInterventionaltherapy

Liquidreplacement3Htherapy(Hypervolemia,hypertention,hemodilution)Drugs

V-PshuntCraniotomy1.supraorbitallateralapproach(SOL)----2.Keyhole3.Pterionalapproach----classicPterionalapproachCraniotomy--PterionalapproachInterventionaltherapyInterventionaltherapyInterventionaltherapy:Frame-assistedInterventionaltherapy:Frame-assisted

DSA:AcoAANEmbolizationBeforeAfter

Lateral思考題1、何謂3H療法？2、CTA與DSA在動脈瘤診斷中各有何優(yōu)劣勢？3、開顱動脈瘤夾閉術(shù)后常見并發(fā)癥？做人要知足，做事要不知足，做學問要知不足。

--裘法祖Agoodsurgeonmusthaveaneagle'seye,alion'sheart,an