颅内动脉瘤的诊断及治疗(讲课用).ppt

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,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,Epidemiology,Morbility:6,35.3/100 thousands,area,：,Lowest,：,India,、,the Middle East,、,China,1,2/100 thousands,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.,Aneurysm etiology,1,、,Congenital 80%,90%,2,、,Arteriosclerosis 10%,18%,3,、,Infective 0.5%,2.0%,4,、,Traumatic 0.5%,Risk factors,1,、,Age,2,、,heredity,3,、,blood flow dynamic,4,、,Defects in the arterial wall of the middle,5,、,Aneurysms coexist with other congenital anomalies,6,、,Hypertension,Aneurysm classification,size,：,1.S,：,0.5cm,；,2.M,：,0.5-1.4cm,；,3.L,：,1.5-2.4cm,；,4.H,：,2.5cm,Aneurysm classificationshape,：,1,、,capsular 2,、,intervallum 3,、,Fusiform,anterior of Willis arterial circle 80%,internal carotid artery ICA30%,anterior cerebral artery ACA 30%,middle cerebral artery MCA 20%,vertebral artery,and basilar artery VA&BA5%,others 15%,Aneurysm classificationcommon position:,Aneurysm classificationposition:,Rhoton,Albert L.,Neurosurgery.51(4),October 2002,0,Locations,of aneurysm rupture,Top 64%,Middle 10%,Neck 2%,unclear,24%,Top-rupture,Clinical presentation of intracranial aneurysmnon-rupture1,、,No clinical symptoms,physical examination when the accidental discovery2,、,Intracranial pressure symptoms,Clinical presentation of aneurysm rupture,meningeal irritative sign:Headache,vomit,neck rigidity,hemiplegia,aphemia,Epilepsy,unconsciousness,Intracerebral hematoma,Communicate-hydrocephalus,Cerebral vasopasm,Hunt&Hess grading,Hunt&Hess,（,1968,）（,1974,）,No Symptom or headache,neck rigidity,cerebral N palsy(,),Moderate to severe headache,neck rigidity,Drowsiness or confusion,Mild neurological deficits,Coma,in moderate to severe hemiplegia,Early decerebrate rigidity,Deep coma,decerebrate rigidity,moribund,Examination&Diagnosis,1,、,Lumbar puncture:caution!,2,、,CT&CTA,3,、,MRI&MRA,4,、,DSA,Lumbar puncture,CT,CTA,（,3D-animation),CTA,（,modelling surgical approach),CTA,（,show the clip after op),MRI&MRA,MRA,DSA,DSA:L-OphA AN,CTA:nagetive,DSA:L-PICA AN,CTA:L-PcoA AN DSA:L-PcoA Shadow,DSA:nagetive,CTA:R-PcoA AN&R-OphA AN,Treatment,Hemorrhage,Cerebral,Vasospasm,Hydrocephalus,Rest in bed,Drugs,Op OR Interventional therapy,Liquid replacement,3H therapy,(Hypervolemia,hypertention,hemodilution),Drugs,V-P shunt,Craniotomy,1.supraorbital lateral approach(SOL)-,2.Key hole,3.Pterional approach -,classic,Pterional approach,Craniotomy-,Pterional approach,Interventional therapy,Interventional therapy,Interventional therapy:Frame-assisted,Interventional therapy:Frame-assisted,DSA:AcoA AN Embolization,Before After,Lateral,思考题,1,、何谓,3H,疗法？,2,、,CTA,与,DSA,在动脉瘤诊断中各有何优劣势？,3,、开颅动脉瘤夹闭术后常见并发症？,做人要知足，做事要不知足，做学问要知不足。,-,裘法祖,A good surgeon must have an eagles eye,a lions heart,and a ladys hand.,一个高超的外科医生应有一双鹰的眼睛，一颗狮子的心和一双女人的手。,-,伦,赖特,愿与各位同道共勉之！,