The surgical treatment of vertebral-basilar aneurysms.
The surgical treatment of vertebral-basilar aneurysms.
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椎基底动脉瘤的手术治疗。
DOI：
10.1093/neurosurgery/16.cn_suppl_1.114
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发表时间：
1969
期刊：
影响因子：
--
通讯作者：
C. Drake
中科院分区：
文献类型：
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作者：
C. Drake
在此期间，我们单位的外科技术有了相当大的变化。1962年，低温疗法被废弃，因为它不能解决早期手术的问题。在出血后几小时或几天内的手术，即使是在中等或深度低温下，通常也会以灾难告终，主要是因为术后动脉痉挛，我仍然认为这是早期手术最可怕的后果。另一方面，晚期手术的病例对I110ST部分并不敏感，无论它们是否冷却。出血后晚期，可以广泛操作动脉瘤及其载瘤血管，而不会产生痉挛。因此，我们学会了将手术治疗推迟一周。之所以选择7天的神奇数字，是因为在我们的病例研究中，从出血到手术导致严重术后痉挛SI11的平均时间为5天，而从轻微或没有痉挛的平均时间为10天(1)。因此，7天是快乐的中间阶段，7天后的痉挛已被证明是罕见的。当然，如果出现明显的血栓或反复出血，应立即进行手术。在延迟的一周内，试图通过镇静和抗高血压药物降低血压来防止患者再次出血。抗纤溶酶cpsilo-氨基己酸正在试验中，其想法是可以减少血栓的溶解，封闭动脉瘤中的裂缝。动脉瘤的脆弱性质一直是它们安全闭塞的障碍。在正常血压下，暴露时破裂并不少见，而视野的模糊往往阻碍了颈部准确解剖的完成。1962年后，我们恢复了正常体温下的人工降压，最初是中等水平，70-80 mm。HG，但在过去的5年里，
During this period, there has been considerable change in surgical technique in our unit. Hypothermia was abandoned in 1962 because it did not solve the problems of early surgery. An operation within a few hours or days of a haemorrhage, even under moderate or deep hypothermia, usually ends in disaster, principally because of postoperative arterial spasm, which I still consider the most dreaded consequence of early surgery.On the other hand, cases operated upon late did'Nell for the I110St part, whether or not they were cooled. Late after bleeding, one can manipulate an aneurysm and its parent vessels extensively without producing spasm. We learned, consequently, to delay surgical treatment for 1 week. The magic number of 7 days was chosen since, in a study of our cases, the average t. ime from haemorrhage to an operation resulting in severe postoperative spaSI11 was 5 days, whereas to little or no spasm, 10 days (1). Seven days, then, was the happy medium and spasm after 7 days has proved to be rare. Of course, an immediate operation is carried out if there is significant clot present or repeated bleeding. During the week of delay, an attempt is made to keep the patient safe from rebleeding by reducing the blood pressure with sedation and antihypertensive agents. The antifibrinolysin cpsilo-aminocaproic acid is under trial, with the idea that it may reduce the lysis of the clot sealing the rent in the aneurysm. The fragile nature of aneurysms has been a barrier to their safe occlusion. At normal blood pressures, rupture was not uncommon during their exposure, and the obscuration of the field often prevented the completion of an accurate dissection at the neck. After 1962, we returned to artificial hypotension at normal body temperature, At first, moderate levels, 70 to 80 mm. Hg, were used but, in the past 5 years,