0
Rhoton, Albert L. Neurosurgery. 51(4), October 2002
.
8
Locations of aneurysm rupture
Top Middle Neck unclear
64% 10% 2%
24%
Top-rupture
.
9
Clinical presentation of intracranial aneurysm
meningeal irritative sign : Headache, vomit, neck rigidity
hemiplegia
aphemia
Epilepsy
unconsciousness
Intracerebral hematoma
Communicate -hydrocephalus
Cerebral vasopasm
➢ Highest：Finland、Japan、Scotland 26.4～96.1/100 thousands
➢ F:M 1.3～1.6:1。Common age:40-60 years ， about2/3。
Linn FH, Rinkel GJ, Algra A, van Gijn J. Incidence of subarachnoid hemorrhage: role of region, year, and rate of computed tomography: a meta-analysis. Stroke. 1996 Apr;27(4):625-9.
颅内动脉瘤的诊断及治疗
Intracranial aneurysm diagnosis and therapy
苏州大学附属第一医院神经外科 王晶
.
1
Epidemiology ➢ Morbility : 6～35.3/100 thousands
➢ area ：
➢ Lowest：India、the Middle East 、China 1 ～2/100 thousands
1、Lumbar puncture: caution! 2、CT&CTA 3、MRI&MRA 4、DSA
.
13
Lumbar puncture
.
14
CT
.
15
CTA（3D-animation)
.
16
CTA（modelling surgical approach)
.
17
CTA（show the clip after op)
.
2
Aneurysm etiology
1、Congenital 80%～90% 2、Arteriosclerosis 10%～18% 3、Infective 0.5%～2.0% 4、Traumatic 0.5%
.
3
Risk factors
1、Age 2、heredity 3、blood flow dynamic 4、Defects in the arterial wall of the
internal carotid artery
ICA
anterior cerebral artery ACA
middle cerebral artery MCA
vertebral artery
and basilar artery VA&BA
others
30% 30% 20%
5% 15%
.
7
Aneurysm classification position:
middle 5、Aneurysms coexist with other
congenital anomalies 6、Hypertension
.
4
Aneurysm classification
size：1.S：＜0.5cm；2.M：0.5-1.4cm；3.L：1.5-2.4cm；4.H：≥2.5cm
V-P shunt
26
Craniotomy
Hemorrhage Cerebral Vasospasm
Hydrocephalus
.
Rest in bed Drugs Op OR Interventional therapy
Liquid replacement 3H therapy (Hypervolemia, hypertention,hemodilution) Drugs
.
5
Aneurysm classification shape：1 、capsular 2、intervallum 3、Fusiform
.
6
Aneurysm classification common position:
anterior of Willis arterial circle > 80%
Mild neurological deficits
Ⅳ
Coma, in moderate to severe hemiplegia
Early decerebrate rigidity
Ⅴ
Deep coma, decerebrate rigidity, moribund
.
12
Examination & Diagnosis
non-rupture 1、No clinical symptoms, physical examination when the accidental discovery 2、Intracranial pressure symptoms
.
10
Clinical presentation of aneurysm rupture
.
11
Hunt&Hess grading
Hunt&Hess （1968）（1974）
Ⅰ
No Symptom or headache, neck rigidity
Ⅱ
cerebral N palsy (Ⅲ, Ⅳ)
Moderate to severe headache, neck rigidity
Ⅲ
Drowsiness or confusion
.
18
MRI&MRA
.
19
MRA
.
20
DSA
.
21
DSA:L-OphA AN
.
22
CTA:nagetive
DSA:L-PICA AN
.
23
CTA:L-PcoA AN
DSA:L-PcoA Shadow
.
24
DSA:nagetive
.
CTA:R-PcoA AN &R-OphA AN
25
Treatment