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首页> 外文期刊>The Canadian Journal of Neurological Sciences: le Journal Canadien des Sciences Neurologiques >Microsurgical Vascular Manipulation in Aneurysm Surgery and Delayed Ischemic Injury
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Microsurgical Vascular Manipulation in Aneurysm Surgery and Delayed Ischemic Injury

机译：动脉瘤手术和延迟缺血性损伤的显微外科血管操纵

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Background: The role of aggressive surgical manipulation with clot evacuation, arachnoid dissection, and papaverine-guided adventitial dissection of large vessels during ruptured aneurysm surgery in reducing vasospasmis controversial. Here we describe a single-institution experience in aneurysm surgery outcomes with and without aggressive surgery. Methods: We performed retrospective analysis of all patients >18 years of age with subarachnoid hemorrhage (SAH) from anterior circulation aneurysms between 2008 and 2013 at the University of New Mexico Hospital. Vasospasm was characterized on days 3 through 14 after SAH based on: (1) angiography, (2) vasospasm requiring angiographic intervention, (3) development of delayed ischemic neurologic deficit (DIND), and (4) radiological appearance of new strokes. Results: Of 159 patients, 114 (71.6%) had "aggressive" and 45 (28.3%) had standard microsurgery. More than 60% of patients presented with a Hunt and Hess score of >= 3 and a Fisher grade (FG) of 4. Compared with standard surgery, there was a statistically significant decrease in the incidence of DIND in patients undergoing aggressive surgery (18.4% vs 37.8%, p = 0.01). Moreover, there was a reduction in the number of new strokes by 30% in the aggressive surgery group with moderate or higher degrees of vasospasm (46.0% vs 76.5%, p = 0.06). In the same group with FG 4 SAH, however, this difference was more than 50% (30% vs 64.7%, p = 0.02). Conclusions: We conclude that aggressive surgical manipulation during aneurysm surgery results in lower incidence of DIND and new strokes. This effect is most pronounced in patients with FG 4 SAH.
机译：背景：在减少动脉瘤手术中的凝固性外科手术治疗凝块疏散，蛛网膜剖面和罂粟引导的罂粟引导过度解剖，在减少血管痉挛的争论中的矛盾瘤。在这里，我们描述了在有攻击手术的动脉瘤手术结果中的单一机构经验。方法：在新墨西哥州医院2008年至2013年期间，我们对蛛网膜下腔出血（SAH）进行了对蛛网膜下腔出血（SAH）的所有患者的回顾性分析。基于：（1）血管造影，（2）血管痉挛，（3）血管造影的血管术，（3）延迟缺血性神经系统缺陷（DIND）的发展，（3）血管痉挛，（4）新冲程的放射性外观，（3）血管痉挛，（3）结果：159例患者，114名（71.6％）“侵略性”，45（28.3％）具有标准显微功能。超过60％的患者呈现出狩猎和HESS评分> = 3和4.与标准手术相比，捕捞级别（FG）和4.与标准手术相比，在接受侵袭性手术的患者中，DIND发生率有统计学显着下降（18.4 ％vs 37.8％，p = 0.01）。此外，在侵袭性手术组中，血管痉挛中等或更高血管痉挛的侵袭性手术组的新冲程数量减少了（46.0％Vs 76.5％，P = 0.06）。然而，在与FG 4 SAH的同一组中，这种差异超过50％（30％vs 64.7％，p = 0.02）。结论：我们得出结论，动脉瘤手术过程中的激进手术治疗导致Dind和New Strokes的发病率降低。这种效果在FG 4 SAH患者中最为明显。

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