Sundt T M, Kobayashi S, Fode N C, Whisnant J P
J Neurosurg. 1982 Jun;56(6):753-65. doi: 10.3171/jns.1982.56.6.0753.
Data from 722 consecutive causes with intracranial aneurysms were stored in a computer and later retrieved for analysis. Results and complications (including preoperative death and morbidity) of the surgical management of these patients were correlated with the Botterell grade of the patient in individuals with a recent subarachnoid hemorrhage (SAH), with the type of aneurysm, and with the timing of the surgical procedure. Patients with no SAH within 30 days prior to hospital admission were classified as "no SAH." Approximately 30% of all patients had sustained more than one hemorrhage. Death and morbidity rates prior to surgery in good-grade patients with a recent SAH exceeded the risk of surgery itself. Rebleeding was the primary cause for death and morbidity in Grade 1 patients: 3% of Grade 1 patients died from a recurrent hemorrhage and 7% deteriorated to a lower grade. Deterioration from ischemia produced by vasospasm related or unrelated to rebleeding exceeded the risks of rebleeding in Grade 2 patients. There was an operative morbidity of 2% and mortality of 2% in patients who were classified as Grade 1 at the time of surgery, but an overall management morbidity of 3% and mortality of 6% in patients who were in Grade 1 at the time of hospital admission. Early surgery in Grade 1 patients was not associated with an increased incidence of delayed ischemia postoperatively. In Grade 2 patients, the operative morbidity and mortality was 7% and 4%, respectively, and the management morbidity and mortality 16% and 11%, respectively. Early surgery in this group was associated with a high frequency of postoperative delayed ischemia (particularly in patients with more than one SAH). Epsilon-aminocaproic acid appeared to protect against a rebleed, gut was associated with a higher incidence of postoperative pulmonary emboli. Intraoperative complications were related both to the size of the aneurysm and to its location. Repair of multiple aneurysms did not adversely affect the result. The surgical approach, the importance of using a self-retaining brain retractor, and the technical complications in these cases are discussed.
收集了722例颅内动脉瘤连续病例的数据并存储于计算机中，随后调出进行分析。这些患者外科治疗的结果及并发症（包括术前死亡和发病情况）与近期发生蛛网膜下腔出血（SAH）患者的Botterell分级、动脉瘤类型以及手术时机相关。入院前30天内无SAH的患者被归类为“无SAH”。所有患者中约30%经历过不止一次出血。近期发生SAH的病情分级良好患者术前的死亡率和发病率超过了手术本身的风险。再出血是1级患者死亡和发病的主要原因：3%的1级患者死于再次出血，7%病情恶化至更低级别。2级患者中，由与再出血相关或无关的血管痉挛导致的缺血性病情恶化超过了再出血的风险。手术时被归类为1级的患者手术发病率为2%，死亡率为2%，但入院时为1级的患者总体治疗发病率为3%，死亡率为6%。1级患者早期手术与术后迟发性缺血发生率增加无关。2级患者手术发病率和死亡率分别为7%和4%，治疗发病率和死亡率分别为16%和11%。该组患者早期手术与术后迟发性缺血的高发生率相关（尤其是在发生不止一次SAH的患者中）。ε-氨基己酸似乎可预防再出血，但与术后肺栓塞的较高发生率相关。术中并发症与动脉瘤大小及其位置均有关。多发动脉瘤的修复并未对结果产生不利影响。文中讨论了手术入路、使用自持式脑牵开器的重要性以及这些病例中的技术并发症。
