颅内动脉瘤的诊断及治疗(讲课用)

颅内动脉瘤的诊断及治疗 Intracranialaneurysmdiagnosisandtherapy 苏州大学附属第一医院神经外科王晶 Epidemiology Morbility 6 35 3 100thousandsarea Lowest India theMiddleEast China1 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 Aneurysmetiology 1 Congenital80 90 2 Arteriosclerosis10 18 3 Infective0 5 2 0 4 Traumatic0 5 Riskfactors 1 Age2 heredity3 bloodflowdynamic4 Defectsinthearterialwallofthemiddle5 Aneurysmscoexistwithothercongenitalanomalies6 Hypertension Aneurysmclassification size 1 S 0 5cm 2 M 0 5 1 4cm 3 L 1 5 2 4cm 4 H 2 5cm Aneurysmclassificationshape 1 capsular2 intervallum3 Fusiform anteriorofWillisarterialcircle 80 internalcarotidarteryICA30 anteriorcerebralarteryACA30 middlecerebralarteryMCA20 vertebralarteryandbasilararteryVA BA5 others15 Aneurysmclassificationcommonposition Aneurysmclassificationposition Rhoton AlbertL Neurosurgery 51 4 October2002 0 Locationsofaneurysmrupture Top64 Middle10 Neck2 unclear24 Top rupture Clinicalpresentationofintracranialaneurysmnon rupture1 Noclinicalsymptoms physicalexaminationwhentheaccidentaldiscovery2 Intracranialpressuresymptoms Clinicalpresentationofaneurysmrupture meningealirritativesign Headache vomit neckrigidityhemiplegiaaphemiaEpilepsyunconsciousnessIntracerebralhematomaCommunicate hydrocephalusCerebralvasopasm Hunt Hessgrading Examination Diagnosis 1 Lumbarpuncture caution 2 CT CTA3 MRI MRA4 DSA Lumbarpuncture CT CTA 3D animation CTA modellingsurgicalapproach CTA showtheclipafterop MRI MRA MRA DSA DSA L OphAAN CTA nagetiveDSA L PICAAN CTA L PcoAANDSA L PcoAShadow DSA nagetiveCTA R PcoAAN R OphAAN Treatment HemorrhageCerebralVasospasmHydrocephalus RestinbedDrugsOpORInterventionaltherapyLiquidreplacement3Htherapy Hypervolemia hypertention hemodilution DrugsV Pshunt Craniotomy1 supraorbitallateralapproach SOL 2 Keyhole3 Pterionalapproach classicPterionalapproach Craniotomy Pterionalapproach Interventionaltherapy Interventionaltherapy Interventionaltherapy Frame assisted Interventionaltherapy Frame assisted DSA AcoAANEmbolizationBeforeAfter Lateral 思考题 1 何谓3H疗法 2 CTA与DSA在动脉瘤诊断中各有何优劣势 3 开颅动脉瘤夹闭术后常见并发症 做人要知足 做事要不知足 做学问要知不足 裘法祖 Agoodsurgeonmusthaveaneagle seye alion sheart andalady shand 一个高超的外科医生应有一双鹰的眼睛 一颗狮子的心和一双女人的手 伦 赖特愿与各位同道共勉之