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,Intracranial aneurysm diagnosis and therapy,苏州大学附属第一医院神经外科 王晶,Epidemiology,Morbility : 635.3/100 thousands area ： Lowest：India、the Middle East 、China 1 2/100 thousands Highest：Finland、Japan、Scotland 26.496.1/100 thousands F:M 1.31.6:1。Common age:40-60 years ， about2/3。,Linn FH, Rinkel GJ, Algra A, van Gijn J. Incidence of subarachnoid hemorrhage: role of region, year, and rate of computed tomography: a meta-analysis. Stroke. 1996 Apr;27(4):625-9.,Aneurysm etiology,1、Congenital 80%90% 2、Arteriosclerosis 10%18% 3、Infective 0.5%2.0% 4、Traumatic 0.5%,Risk factors,1、Age 2、heredity 3、blood flow dynamic 4、Defects in the arterial wall of the middle 5、Aneurysms coexist with other congenital anomalies 6、Hypertension,Aneurysm classification,size：1.S：0.5cm；2.M：0.5-1.4cm；3.L：1.5-2.4cm；4.H：2.5cm,Aneurysm classification shape：1 、capsular 2、intervallum 3、Fusiform,anterior of Willis arterial circle 80% internal carotid artery ICA 30% anterior cerebral artery ACA 30% middle cerebral artery MCA 20% vertebral artery and basilar artery VA&BA 5% others 15%,Aneurysm classification common position:,Aneurysm classification position:,Rhoton, Albert L. Neurosurgery. 51(4), October 2002,0,Locations of aneurysm rupture,Top 64% Middle 10% Neck 2% unclear 24%,Top-rupture,Clinical presentation of intracranial aneurysm non-rupture 1、No clinical symptoms, physical examination when the accidental discovery 2、Intracranial pressure symptoms,Clinical presentation of aneurysm rupture,meningeal irritative sign : Headache, vomit, neck rigidity hemiplegia aphemia Epilepsy unconsciousness Intracerebral hematoma Communicate -hydrocephalus Cerebral vasopasm,Hunt&Hess grading,Examination & Diagnosis,1、Lumbar puncture: caution! 2、CT&CTA 3、MRI&MRA 4、DSA,Lumbar puncture,CT,CTA（3D-animation),CTA（modelling surgical approach),CTA（show the clip after op),MRI&MRA,MRA,DSA,DSA:L-OphA AN,CTA:nagetive DSA:L-PICA AN,CTA:L-PcoA AN DSA:L-PcoA Shadow,DSA:nagetive CTA:R-PcoA AN &R-OphA AN,Treatment,Hemorrhage Cerebral Vasospasm Hydrocephalus,Rest in bed Drugs Op OR Interventional therapy Liquid replacement 3H therapy (Hypervolemia, hypertention,hemodilution) Drugs V-P shunt,Craniotomy 1.supraorbital lateral approach (SOL) - 2.Key hole 3.Pterional approach -classic Pterional approach,Craniotomy -Pterional approach,Interventional therapy,Interventional therapy,Interventional therapy:Frame-assisted,Interventional therapy:Frame-assisted,DSA:AcoA AN Embolization Before After,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