目的 探讨支架辅助颅内动脉瘤栓塞术后急性血栓形成的原因、干预及预防措施.方法 回顾性分析自2016年9月-2017年6月本院15例接受支架辅助颅内动脉瘤栓塞术的颅内动脉瘤的患者, 收集包括病史、体征、辅助检查、手术过程、影像学资料.结果 15例患者中3例发生支架内急性血栓形成, 患者术后未苏醒或醒后发生肢体活动障碍或数小时再次昏迷, 再次行全脑血管造影证实支架内急性血栓形成, 给予动脉内溶栓治疗后均获再通, 无溶栓及血栓形成相关致残致死情况发生.结论 支架辅助颅内动脉瘤栓塞术后支架内急性血栓形成原因较多, 娴熟的手术技术、积极的干预措施以及准确的术前评估可减少或避免不良后果发生.

Objective To investigate the efficacy and safety of predictive early bilateral decompressive craniectomy in the treatment of severe traumatic brain injury (sTBI). Methods A total of 92 patients with sTBI underwent predictive early bilateral decompressive craniectomy (observation group, N = 42) and conservative first-line treatment followed by unilateral or bilateral decompressive craniectomy (control group, N = 50). Intracranial pressure (ICP) before and after treatment was monitored, Glasgow Outcome Scale (GOS) was used to evaluate prognosis, and postoperative complications were recorded. Results The observation group patients had less time interval than control group patients [(4.63 ± 1.61) h vs. (36.61 ± 1.92) h; t = 32.464, P = 0.001]. Compared with before operation, ICP decreased 1 d after operation (P = 0.001), and continued to decrease 7 d after operation (P = 0.001) in both groups. Compared with control group, the ICP in observation group patients decreased more (P = 0.001). Of 92 patients, 37 had a good prognosis (40.22% ) and 55 had a poor prognosis (59.78% ). The rate of good prognosis in observation group was significantly higher than that in control group [54.76% (23/42) vs. 28% (14/50); χ2 = 5.697, P = 0.017]. The good prognosis rate of patients less than 41 years old was significantly higher than that of patients older than 41 years old ( χ2 = 5.526, P = 0.025). Of 92 patients, 31 (33.70% ) had postoperative complications, including 11 cases (11.96% ) of subdural effusion, 4 cases (4.35% ) of intracranial hemorrhage, 3 cases (3.26%) of hydrocephalus, 4 cases (4.35%) of infection, 2 cases (2.17%) of epilepsy and 7 cases (7.61% ) of organ dysfunction. The postoperative complication rate in observation group was lower than that in control group [21.43% (9/42) vs. 44% (22/50); χ2 = 5.205, P = 0.022]. Conclusions Predictive early bilateral decompressive craniectomy for sTBI could reduce ICP, prevent delayed intracranial hematoma caused by unilateral decompressive craniectomy, significantly improve the prognosis, decrease the incidence of postoperative complications, and improve the patients' quality of life.

Objective To explore the efficacy of microsurgical standard pterional approach, interhemispheric approach and combined approaches for clipping anterior communicating artery aneurysms, and the principles for choosing microsurgical approaches.Methods The clinical data of 78 patients with anterior communicating artery aneurysms treated in our hospital from January, 2012 to June, 2015 were analyzed retrospectively.All of the patients were diagnosed with CTA or DSA.39 cases were treated by standard pterional approach, 34 cases by interhemispheric approach and 5 cases by combined approaches.Results According to the Glasgow Outcome Scale, 29 cases by standard pterion approach, 25 cases by interhemispheric approach and 5 cases by combined approaches had good recovery at six months after hospital discharge.Conclusions Early treatment of anterior communicating artery aneurysms by standard pterional approach, interhemispheric approach and combined approaches is effective and has favorable prognosis.Choosing proper microsurgical approach according to aneurysm points is the basis of successful microsurgery.