Abstract: 【Abstract】〓Objective〓To explore the feasibility and clinical value of endovascular embolization combined with craniectomy for hematoma elimination and decompression in treating Hunt-Hess Ⅲ- Ⅳ merger intracranial hematoma in patients with intracranial aneurysm rupture. Methods〓Twelve cases with intracranial aneurysm rupture admitted in our hospital from March 2009 to February 2014 and underwent above endovascular embolization and surgical treatment. The patients need meet following conditions for operation indication,firstly,the patients were with spontaneous subarachnoid hemorrhage along with intracranial hematoma and with Hunt-Hess classification in Ⅲ-grade Ⅳ at the onset. Secondly,the head CT scan showed the brain shift of the midline >0.5 cm but <1.0 cm. Thirdly,cerebral angiogram found intracranial aneurysm and successful embolization and decompression craniectomy. Results〓No case was dead. GOS scores at 3 months of follow-up were 5 points in 7 cases, 4 points in 2 case, 3 points in 2 cases, 2 points one case. Conclusion〓For the patients suffered from intracranial aneurysm rupture, endovascular embolization combined with craniectomy for hematoma elimination and decompression may be a good treatment choice.

Key words: Intracranial hematoma, Intracranial aneurysms bleeding, Endovascular treatment

摘要：

【摘要】〓目的〓探讨通过血管内栓塞术后结合开颅减压术的方法治疗Hunt-Hess分级III-IV级合并颅内血肿的脑动脉瘤破裂病人的可行性和临床价值。方法〓选取2009年3月~2014年2月于我院治疗的颅内动脉瘤破裂出血病人共12例。符合以下条件:①自发性蛛网膜下腔出血合并颅内血肿形成;②Hunt-Hess分级在III-IV级;③头颅CT扫描显示脑中线移位>0.5 cm但<1.0 cm;④经过脑血管造影发现颅内动脉瘤并成功栓塞,然后转手术室再行减压手术。结果〓本组无死亡病例。12例患者术后3个月~1年得以随访,按GOS评分进行疗效评价,5分7例,4分2例,3分2例,2分1例。结论〓合理应用神经放射介入技术和外科手术,对合并血肿的脑动脉瘤破裂出血病人是另一种治疗选择。

关键词: 颅内血肿, 颅内动脉瘤破裂出血, 脑疝, 血管内治疗, 去骨瓣减压