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Rupture of intracranial aneurysm in 2006 the death rate of nearly 40% mortality after re-bleeding is about 50% ~ 75%, r1J. Therefore, timely detection of intracranial aneurysms, and select the appropriate surgical methods to improve surgical techniques, active control aneurysm re-bleeding in patients with intracranial aneurysm to reduce death, disability rate, is important to improve clinical efficacy. Hospital from June 2001 to September 2005, 36 cases of ruptured intracranial aneurysms in patients taking early microsurgical treatment, satisfactory results, reported below. 1 Data and methods 1.1 General Information The group of 36 patients, 19 male, female 14 cases. Age 32 to 72 years, mean (4J4.3 11.8) years. Including the posterior communicating artery aneurysm in 13 cases, nine cases of anterior communicating artery aneurysm, middle cerebral artery aneurysm and its branches in 6 cases, intracranial internal carotid artery aneurysm in 5 cases, the last paragraph of basilar artery aneurysm in 2 cases, the eye paraclinoid artery bifurcation aneurysm in 1 case. According to Hunt-Hess grade: I ~ III level in 27 cases, III in 9 cases above. Headache, vomiting, subarachnoid hemorrhage (SAH) typically show 21 cases, 11 cases associated with disturbance of consciousness; to ptosis, blurred vision and other performance of the oculomotor nerve palsy in 6 cases; sudden coma, and limbs, paralysis, brain hernia in 5 cases. After admission were confirmed by head CT or MRI examinat


ion and CSF laboratory tests confirmed the presence of intracranial hematoma, or subarachnoid hemorrhage, 5 patients with intracranial hematoma ruptured into the ventricle, 4 cases with cerebral infarction, 4 cases with obstructive hydrocephalus . Check the digital silhouette emergency angiography () SA) confirmed 34 cases of cerebral aneurysms as a single, two or more cerebral aneurysms in 2 cases. 1.2 The group of 36 patients with surgical methods were microscopic surgery within 72h after the onset of clipping. Surgical Methods Yasargil pterional, craniotomy cut the dura, the microscope fully reveal the lateral fissure, and then by the side of the cistern and skull base cerebrospinal fluid of the brain pool of slowly released to snake retractor automatically pull the amount of structure, temporal lobe, the sylvian artery rings exposed base of the skull and reach willis aneurysm Department (of which paraclinoid aneurysms need to wear except the first intradural clinoid to reveal aneurysm), and fully dissecting aneurysm and surrounding tissue, microscope, look down the neck aneurysms clipped. 2 Results after 3 patients died, including 2 cases of postoperative bleeding and broken into the ventricle, brain herniation, the patient's family to give up treatment after 2 weeks of death; the other 1 case was an exception aneurysm surgery, postoperative combined infarction, 3 days after death. Survival of patients followed up for 3 months, according to Glasgow coma (GOS) prognostic score, of which 23 patients recovered well and can take care of themselves; 5 cases associated with mild disability, need someone to take care of; 5, severe disability, totally bedridden. 3 to discuss the occurrence of intracranial aneurysms and cerebral arterial wall cavity partial pressure of increased birth defects and related, more common in cerebral artery bifurcation, according to disease site, 70% in the first half of the cerebral arterial circle to the neck artery, posterior communicating artery, anterior communicating artery were more common, is still found in the middle cerebral artery or a branch of the anterior cerebral artery; cerebral arterial circle about half of those 30%, occurred in the basilar artery, posterior cerebral artery and its branches "0. 36 cases were operated, most of them (34 cases), carotid aneurysm. clinical SAH more than 80% * caused by a ruptured aneurysm. artery rupture whenever there was a premonitory symptoms such as headache, followed by bleeding symptoms, manifested as severe headache, irritability, nausea, vomiting, meningeal irritation, increased intracranial pressure appears. may be associated with disturbance of consciousness and the corresponding parts of the symptoms of nerve localization. artery Tumor formation of large hematomas were bleeding, more rapid deterioration of the disease, there herniation crisis. According to statistics, the first rupture of aneurysm, the mortality rate as high as 30% to 40%, most of them died within 48h after the onset of the survival of the cases About 30% of re-bleeding can occur. Aneurysm rupture is a spontaneous subarachnoid hemorrhage (SAH) of the main reasons for death, disability rate high, seriously affecting the health of patients "J. Thus improve the diagnosis and treatment of cerebral aneurysms, ruptured aneurysms effective prevention and treatment, is of great significance. Aneurysm neck clipping surgery is an effective treatment method for intracranial aneurysms "J. With neurosurgery gradually extended, and its good lighting and visual effects, sound knowledge of microscopic anatomy and micro-invasive technique, which greatly improved the surgical safety. aneurysm surgery timing, and intraoperative and postoperative management and proper operation of the prevention of complications, are to improve the surgical treatment of intracranial aneurysms microscopy results have important implications. On the timing of aneurysm surgery different of different scholars. Over the past that early rupture (3d within) the cerebral edema, cerebral vasospasm and other factors exist, decreased ability to tolerate surgery patients and increase the difficulty of operation, multiple claims extension (2 weeks) surgery. In recent years, some academics have suggested ruptured intracranial aneurysm rebleeding within 1 week after the highest incidence of "0, delayed operation to rescue the loss of opportunity; Moreover, early surgical removal of intracranial hematoma, or subarachnoid also the coagulation and bloody cerebrospinal fluid, to reduce intracranial pressure and reduce cerebral vasospasm have a positive effect, it is more than many scholars now advocate early (3d) or ultra-early (7h in) operations H0. 3F cases of this group were within 72h after the onset of surgery, the treatment effect is good. Of course, the choice of timing of surgery, but also considering the patient's age, state of consciousness, general conditions and other factors. If the patient is old and infirm, deep coma, general poor condition, you should wait until his condition improved after surgery. For further bleeding occurred during the observation period, and those associated with brain herniation, may at any time to save the patient's life operations. One way operation option is key to successful operation, Yasagil wing point of human cerebral aneurysm surgery classic road is the path to expose the main branches of the internal carotid artery and the whole process, and through the lateral fissure intracranial internal carotid artery beginning Department of Anatomy and began to expose, to facilitate intraoperative temporary occlusion of the proximal parent artery to control bleeding, partial anterior circulation aneurysms and posterior circulation aneurysms can use this approach. When formed after rupture of intracranial hematoma, the bleeding site can be appropriately modified according to the specific surgical approach, more in general the amount of bleeding sites, temporal lobe, can be used to expand the amount of temporal lobe craniotomy, or pterional, intraoperative suction near In addition to part of the hematoma, intracranial pressure to be reduced, then dissected, separated parent artery and aneurysm neck and aneurysm clipping. 36 patients in this group are used pterional, separated by the side of the cistern to the skull base arterial rings, vision surgery revealed satisfactory. Intraoperative bleeding occurred in 1 case, after the temporary occlusion of parent artery occlusion, postoperative patients because of severe cerebral vasospasm, combined with massive cerebral infarction, in 3d after death. To improve the success rate of aneurysm surgery, should pay attention to the following aspects: The pterional approach, first isolated in case of internal carotid artery proximal temporary occlusion. Estimates for giant aneurysms or the possibility of intraoperative bleeding large aneurysm, can be dissected in the neck before craniotomy the carotid artery, to prepare the temporary block; fully reveal the lateral fissure surgery full, open side of the crack Pool and base of the skull of the brain pool, in order to facilitate surgical exposure and reduce the brain tissue stretch; carefully dissected and fully reveal the aneurysm neck, intraoperative hypotension can be controlled, if necessary, on a provisional proximal parent artery occlusion side, and with attention to identifying arterial aneurysm neck to prevent the omission of fans and attention to important arterial through the artery; prevention of postoperative complications is also important, such as postoperative calcium channel blocker may be appropriate to increase blood pressure, and can improve vasospasm due to poor cerebral perfusion.
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