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首页> 外文期刊>Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia >Simultaneous microsurgical and endovascular management of multiple cerebral aneurysms in acute subarachnoid haemorrhage.
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Simultaneous microsurgical and endovascular management of multiple cerebral aneurysms in acute subarachnoid haemorrhage.

机译：急性蛛网膜下腔出血的多发性脑动脉瘤同时进行显微外科手术和血管内处理。

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摘要

Most aneurysms can be effectively managed using endovascular coiling or microsurgical clipping, but in an acute subarachnoid haemorrhage where there are multiple aneurysms identified, a sequential multimodal approach may prove more beneficial. This report involves a 31-year-old man who presented with sudden onset of severe headache and photophobia. A computed tomography brain scan revealed a diffuse grade II subarachnoid haemorrhagic pattern, and four-vessel angiography revealed two aneurysms: a right middle cerebral artery bifurcation aneurysm measuring 12 x 8 mm and a 4-mm basilar artery aneurysm associated with a fenestration at the confluence of the vertebral arteries. It was not possible to determine which aneurysm or aneurysms were responsible for the haemorrhage using the customary criteria. The patient underwent sequential endovascular coiling of the vertebrobasilar aneurysm without delay, followed immediately by microsurgical clipping of the right middle cerebral artery aneurysm, under a single anaesthetic. The postoperative course was uneventful. This method is a treatment option for acute subarachnoid haemorrhage where there are multiple aneurysms. It is a logical progression of management that could be employed at any experienced neurovascular centre; the employment of a sequential multimodal approach from the integration of these techniques is beneficial to the patient because it decreases morbidity and mortality.
机译：大多数动脉瘤可以使用血管内盘绕术或显微外科手术夹钳进行有效处理，但是在急性蛛网膜下腔出血中，如果发现了多个动脉瘤，则采用顺序多模式方法可能会更加有益。该报告涉及一名31岁的男子，他突然发作严重的头痛和畏光。计算机断层扫描脑部扫描显示弥漫性II级蛛网膜下腔出血模式，四支血管造影显示两个动脉瘤：右脑中动脉分叉动脉瘤（尺寸为12 x 8 mm）和4毫米基底动脉动脉瘤（与汇合处的开窗有关）椎动脉。使用常规标准无法确定是哪个或哪些动脉瘤引起出血。患者在没有麻醉的情况下连续经历椎基底动脉瘤的血管内连续coil绕，然后在一次麻醉下立即显微外科切除右脑中动脉瘤。术后过程很顺利。这种方法是治疗多发性动脉瘤的急性蛛网膜下腔出血的一种治疗选择。在任何经验丰富的神经血管中心均可采用这种顺理成章的管理方法。从这些技术的整合中采用顺序多模式方法对患者有益，因为它降低了发病率和死亡率。

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