The modern history of the management of intracranial aneurysm encompasses little more than a quarter century. These are seen in 5% routine autopsies and those under 2 mm exist in 17% normal adult brain vasculature. One third of strokes are SAH and aneurysms account for 70% of these. Aneurysms rupture at a rate of 12/100.000 population/year, mostly on the 5th, and 6th decades. Given the high morbidity and mortality of these (43% from first haemorrhage if untreated), surgeons can attempt to avoid rebleeding for a week or more until surgery becomes safe and expand the ability to deal safely with most of them regardless of size or position. Early surgery has still an unacceptable morbidity and operation is usually planned between the 6th and 10th day after the first bleed. Early surgery is only indicated when there is a clot and deterioration. Conservative measures are reduction of blood pressure and use of antifibrinolysins and some minor surgical means whose practicality is still unknown. The recognition of warning leaks must be one of the significant factors for future treatment. Several surgical adjuncts are of considerable value, i.e., brain shrinking agents, microsurgical technique, induced hypotension. Aneurisms are classified as: small (less than 12 mm) large or bulbous (12-25 mm) and giant (greater than 25 mm). From 326 of small vertebral-basilar aneurysms the results were excellent in 246, good in 35, poor in 26 and 19 died. From 71 basilar aneurysms only 6 died, the results being excellent in 42, good in 10 and poor in 13. The management of giant anterior circulation (Table III) and posterior circulation (Table IV) aneurysms, involved various surgical procedures including carotid, middle cerebral, vertebral and basilar artery ligation, neck occlusion, wrapping or coating, as an overall result the outcome was good in 52 out of 63 gicunt anterior circulation giant aneurysms but was bad in 48 out of 91 posterior circulation giant aneurysms. The best results were obtained with 7 carotid-cavernous aneurysms (all good) and the worse results with 17 giant aneurysms of the basilar trunk at the superior cerebellar artery (11 poor, 6 good). A technique for the percutaneous occlusion of the basilar artery with a plastic Rommel type tourniquet is described (Fig 3). This allows the occlusion under local anesthesia. It has been used in 10 cases with 2 deaths STA-MCA by-pass proved to be useful for the progressive occlusion of the MCA in 3 cases of giant middle cerebral aneurysms.
颅内动脉瘤的现代治疗史不过二十五年多一点。在5%的常规尸检中可发现这些动脉瘤，在正常成人脑血管系统中，直径小于2毫米的动脉瘤占17%。三分之一的中风是蛛网膜下腔出血（SAH），其中70%由动脉瘤引起。动脉瘤的破裂率为每年12/100000人口，大多发生在五、六十岁。鉴于这些疾病的高发病率和高死亡率（如果不治疗，首次出血后的死亡率为43%），外科医生可以尝试避免再出血一周或更长时间，直到手术变得安全，并扩大安全处理大多数动脉瘤的能力，无论其大小或位置如何。早期手术的发病率仍然难以接受，手术通常计划在首次出血后的第6至10天进行。只有在出现血凝块和病情恶化时才进行早期手术。保守措施包括降低血压、使用抗纤溶药物以及一些实用性尚不清楚的小手术方法。识别警示性渗漏必须是未来治疗的重要因素之一。几种手术辅助手段具有相当大的价值，即脑萎缩剂、显微外科技术、控制性低血压。动脉瘤分为：小型（小于12毫米）、大型或球状（12 - 25毫米）和巨型（大于25毫米）。在326例小型椎基底动脉瘤中，246例效果极佳，35例良好，26例较差，19例死亡。在71例基底动脉瘤中，仅6例死亡，42例效果极佳，10例良好，13例较差。巨型前循环（表III）和后循环（表IV）动脉瘤的治疗涉及各种手术程序，包括颈动脉、大脑中动脉、椎动脉和基底动脉结扎、颈部闭塞、包裹或涂层，总体结果是，63例巨型前循环动脉瘤中有52例效果良好，但91例后循环巨型动脉瘤中有48例效果不佳。7例颈内动脉海绵窦段动脉瘤的治疗效果最佳（均为良好），而17例基底动脉主干小脑上动脉段巨型动脉瘤的治疗效果最差（11例较差，6例良好）。本文描述了一种使用塑料隆梅尔型止血带经皮闭塞基底动脉的技术（图3）。这使得在局部麻醉下即可进行闭塞操作。该技术已应用于10例患者，2例死亡。颞浅动脉 - 大脑中动脉搭桥术被证明对3例巨型大脑中动脉瘤进行大脑中动脉的渐进性闭塞有用。
