颅脑损伤合并颅内动脉瘤破裂诊断及手术治疗—病例报告

Diagnosis and Surgical Treatment of Craniocerebral Injury Combined with Intracranial Aneurysm Rupture—Case Report

摘要: 目的：结合病例探讨颅脑损伤合并颅内动脉瘤破裂出血的诊断及治疗策略。方法：1例61岁女性患者因“头部外伤后进行性意识障碍4小时”入院，头颅CT显示左额颞顶部硬膜下出血，左顶叶脑出血，蛛网膜下腔出血，中线结构明显移位(图1)。头颅CTA显示左侧大脑后动脉远端分支动脉瘤(图2)。结果：术后CTA检查提示动脉瘤夹闭满意，载瘤动脉通畅(图3)。结论：颅脑损伤后出现动脉瘤性脑内血肿者，应考虑颅脑损伤合并颅内动脉瘤破裂的可能性，同时结合病史及影像判断是颅内动脉瘤破裂导致颅脑损伤，还是颅脑损伤导致颅内动脉瘤破裂。此时首选头颅CTA有助于明确诊断且减少术前等待时间，及时行开颅减压，术中同时处理破裂动脉瘤可降低动脉瘤再次破裂风险。

Abstract: Purpose: To study the diagnosis and therapeutic method of craniocerebral injury combined with intracranial aneurysm rupture and hemorrhage. Method: A 61-year-old female patient was hospi-talized for sexual awareness disorder after a head trauma four hours earlier. Head CT showed subdural hemorrhage, left parietal cerebral hemorrhage, subarachnoid hemorrhage, and obvious displacement of the midline structure of the brain (Figure 1). Cephalic CTA shows distal branch aneurysm of left posterior cerebral artery (Figure 2). Results: Postoperative CTA examination in-dicated satisfactory aneurysm occlusion and patency of aneurysmal artery (Figure 3). Conclusion: Aneurysmal brain hematoma after craniocerebral injury, traumatic brain injury with intracranial aneurysm rupture should be considered. At the same time, combining with the history and the image is ruptured intracranial aneurysm in traumatic brain injury, or traumatic brain injury in intracranial aneurysm rupture. At this time, cephalic CTA is preferred to help definite diagnosis and reduce preoperative waiting time, timely craniotomy and decompression, and intraoperative treatment of ruptured aneurysms can reduce the risk of aneurysm rupture again.