Surgical Management of Aneurysmal Subarachnoid Hemorrhage
Surgical Management of Aneurysmal Subarachnoid Hemorrhage
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DOI：
10.1016/j.nec.2009.10.003
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发表时间：
2010-04-01
影响因子：
2.6
通讯作者：
Tamargo, Rafael J.
中科院分区：
文献类型：
--
作者：
Colby, Geoffrey P.;Coon, Alexander L.;Tamargo, Rafael J.
动脉瘤性蛛网膜下腔出血 (aSAH) 是一种常见且往往具有破坏性的疾病，需要及时进行神经外科评估和干预。 aSAH 的现代管理涉及一个由亚专家组成的多学科团队，包括血管神经外科医生、神经重症监护专家，通常还包括神经介入放射科医生。该团队负责稳定患者的就诊情况、诊断有问题的破裂动脉瘤、固定动脉瘤，并在通常漫长而复杂的住院过程中管理患者。自 20 世纪 00 年代初以来，手术干预一直是脑动脉瘤破裂的最终治疗方法。在接下来的几十年里，显微外科技术、辅助操作以及术中和围术期药物治疗方面的许多创新促进了 aSAH 患者的护理。本报告重点关注 aSAH 患者的现代外科治疗。在简要回顾动脉瘤手术的起源之后，讨论的主题包括aSAH后手术干预的时机、常用的手术入路和开颅手术、终板开窗、术中神经生理监测、术中数字减影和荧光血管造影、临时夹闭、深低温体外循环、急性脑积水的治疗、脑血运重建以及新型夹子配置和显微外科技术。本报告中强调的许多主题代表了血管神经外科领域一些更有争议的技术。随着新研究的开展和有关其实用性的数据的出现，此类技术的受欢迎程度不断发展。
Aneurysmal subarachnoid hemorrhage (aSAH) is a common and often devastating condition that requires prompt neurosurgical evaluation and intervention. Modern management of aSAH involves a multidisciplinary team of subspecialists, including vascular neurosurgeons, neurocritical care specialists and, frequently, neurointerventional radiologists. This team is responsible for stabilizing the patient on presentation, diagnosing the offending ruptured aneurysm, securing the aneurysm, and managing the patient through a typically prolonged and complicated hospital course. Surgical intervention has remained a definitive treatment for ruptured cerebral aneurysms since the early 1900s. Over the subsequent decades, many innovations in microsurgical technique, adjuvant maneuvers, and intraoperative and perioperative medical therapies have advanced the care of patients with aSAH. This report focuses on the modern surgical management of patients with aSAH. Following a brief historical perspective on the origin of aneurysm surgery, the topics discussed include the timing of surgical intervention after aSAH, commonly used surgical approaches and craniotomies, fenestration of the lamina terminalis, intraoperative neurophysiological monitoring, intraoperative digital subtraction and fluorescent angiography, temporary clipping, deep hypothermic cardiopulmonary bypass, management of acute hydrocephalus, cerebral revascularization, and novel clip configurations and microsurgical techniques. Many of the topics highlighted in this report represent some of the more debated techniques in vascular neurosurgery. The popularity of such techniques is constantly evolving as new studies are performed and data about their utility become available.