Murias Quintana E, Gil García A, Vega Valdés P, Morales Deza E, Escudero Augusto D, Viña Soria L, Gutiérrez Morales J C
Unidad de Neurorradiología Intervencionista, Servicio de Radiología, Hospital Universitario Central de Asturias, Oviedo, España.
Unidad de Neurorradiología Intervencionista, Servicio de Radiología, Hospital Universitario Central de Asturias, Oviedo, España.
Radiologia (Engl Ed). 2019 Jan-Feb;61(1):42-50. doi: 10.1016/j.rx.2018.09.003. Epub 2018 Nov 3.
To determine whether the urgent embolization of a cerebral aneurysms and posterior surgery on cerebral hematomas is safe and efficacious in patients with hematomas and signs of intracranial hypertension due to the rupture of cerebral aneurysms.
We included 23 consecutive patients in poor clinical condition due to an intracranial hematoma caused by a ruptured cerebral aneurysm who were treated with both embolization and surgery within 4hours of the onset of symptoms. All patients had clinical signs of intracranial hypertension and / or altered levels of consciousness, including coma due to rostrocaudal deterioration. We evaluated the efficacy of the combined technique by determining the degree of closure of the aneurysms and the patients' prognosis one month after the procedures; we evaluated safety by analyzing the complications of the treatments.
All but two of the patients (21/23; 91.3%) had an aneurysm of the middle cerebral artery. All patients scored 4 on the Fisher scale and were classified as Hunt and Hess IV or V. The mean time from the identification of the aneurysm on computed tomography to embolization was 115minutes. A balloon remodeling technique was used in 18 (78%) patients; embolization achieved adequate closure in 19 (82.6%) patients. During surgery, a ventricular drain was placed in 9 (39.1%) patients. One month after treatment, 13 (56.5%) patients were functionally independent and 3 (13%) had died. No episodes of rebleeding were observed.
In our experience, combined treatment including embolization of the aneurysm and surgical decompression with evacuation of the hematoma is a safe and effective alternative to surgical treatment alone.
确定对于因脑动脉瘤破裂导致血肿且伴有颅内高压体征的患者，紧急栓塞脑动脉瘤并随后进行脑血肿手术是否安全有效。
我们纳入了23例因脑动脉瘤破裂导致颅内血肿而临床状况较差的连续患者，这些患者在症状发作后4小时内接受了栓塞和手术治疗。所有患者均有颅内高压的临床体征和/或意识水平改变，包括因头端到尾端恶化导致的昏迷。我们通过确定动脉瘤的闭合程度和术后1个月患者的预后情况来评估联合技术的疗效；通过分析治疗并发症来评估安全性。
除2例患者外，其余所有患者（21/23；91.3%）患有大脑中动脉动脉瘤。所有患者Fisher分级为4级，Hunt和Hess分级为IV级或V级。从计算机断层扫描识别动脉瘤到栓塞的平均时间为115分钟。18例（78%）患者采用了球囊重塑技术；19例（82.6%）患者栓塞后实现了充分闭合。手术过程中，9例（39.1%）患者放置了脑室引流管。治疗1个月后，13例（56.5%）患者功能独立，3例（13%）死亡。未观察到再出血事件。
根据我们的经验，包括动脉瘤栓塞和血肿清除手术减压在内的联合治疗是一种安全有效的替代单纯手术治疗的方法。
