颅内动脉瘤诊断与治疗(讲课用)
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Epidemiology ➢ Morbility : 6～35.3/100 thousands
➢ area ：
➢ Lowest：India、the Middle East 、China 1 ～2/100 thousands ➢ Highest：Finland、Japan、Scotland 26.4～96.1/100 thousands
Mild neurological deficits
Ⅳ
Coma, in moderate to severe hemiplegia
Early decerebrate rigidity
Ⅴ
Deep coma, decerebrate rigidity, moribund
Examination & Diagnosis
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
做人要知足，做事要不知足，做 学问要知不足。
--裘法祖
A good surgeon must have an eagle's eye, a lion's heart,and a lady's hand.
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 ！
Rhoton, Albert L. Neurosurgery. 51(4), October 2002
0
Locations of aneurysm rupture
Top Middle Neck unclear
64% 10% 2%
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
Hunt&Hess grading
Hunt&Hess （1968）（1974）
Ⅰ
No Symptom or headache, neck rigidity
Ⅱ
cerebral N palsy (Ⅲ, Ⅳ)
Moderate to severe headache, neck rigidity
Ⅲ
Drowsiness or confusion
meningeal irritative sign : Headache, vomit, neck rigidity
hemiplegia aphemia Epilepsy unconsciousness Intracerebral hematoma Communicate -hydrocephalus Cerebral vasopasm
1.supraorbital lateral approach (SOL) ---2.Key hole 3.Pterional approach ----classic
Pterional approach
Craniotomy --Pterional approach
Interventional therapy
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)
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
Hydrocephalus
Rest in bed Drugs Op OR Interventional therapy
Liquid replacement 3H therapy (Hypervolemia, hypertention,hemodilution) Drugs
V-P shunt
Craniotomy
ICA
anterior cerebral artery ACA
middle cerebral artery MCA
vertebral artery
and basilar artery VA&BA
others
30% 30% 20%
5% 15%
Aneurysm classification position:
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？
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
来自百度文库
Treatment
Hemorrhage Cerebral Vasospasm
➢ F:M 1.3～1.6:1。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 classification shape：1 、capsular 2、intervallum 3、Fusiform
Aneurysm classification common position:
anterior of Willis arterial circle > 80%
internal carotid artery
➢ area ：
➢ Lowest：India、the Middle East 、China 1 ～2/100 thousands ➢ Highest：Finland、Japan、Scotland 26.4～96.1/100 thousands
Mild neurological deficits
Ⅳ
Coma, in moderate to severe hemiplegia
Early decerebrate rigidity
Ⅴ
Deep coma, decerebrate rigidity, moribund
Examination & Diagnosis
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
做人要知足，做事要不知足，做 学问要知不足。
--裘法祖
A good surgeon must have an eagle's eye, a lion's heart,and a lady's hand.
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 ！
Rhoton, Albert L. Neurosurgery. 51(4), October 2002
0
Locations of aneurysm rupture
Top Middle Neck unclear
64% 10% 2%
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
Hunt&Hess grading
Hunt&Hess （1968）（1974）
Ⅰ
No Symptom or headache, neck rigidity
Ⅱ
cerebral N palsy (Ⅲ, Ⅳ)
Moderate to severe headache, neck rigidity
Ⅲ
Drowsiness or confusion
meningeal irritative sign : Headache, vomit, neck rigidity
hemiplegia aphemia Epilepsy unconsciousness Intracerebral hematoma Communicate -hydrocephalus Cerebral vasopasm
1.supraorbital lateral approach (SOL) ---2.Key hole 3.Pterional approach ----classic
Pterional approach
Craniotomy --Pterional approach
Interventional therapy
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)
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
Hydrocephalus
Rest in bed Drugs Op OR Interventional therapy
Liquid replacement 3H therapy (Hypervolemia, hypertention,hemodilution) Drugs
V-P shunt
Craniotomy
ICA
anterior cerebral artery ACA
middle cerebral artery MCA
vertebral artery
and basilar artery VA&BA
others
30% 30% 20%
5% 15%
Aneurysm classification position:
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？
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
来自百度文库
Treatment
Hemorrhage Cerebral Vasospasm
➢ F:M 1.3～1.6:1。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 classification shape：1 、capsular 2、intervallum 3、Fusiform
Aneurysm classification common position:
anterior of Willis arterial circle > 80%
internal carotid artery