managements medical 1869 surgical 源自1869年的医疗仁道实践 endovascular
managements •medical •surgical •endovascular
1. medical .Lying in bed for more than 4 weeks Avoiding agitation or exertion . haemostatic .Dehydration to reduce intracranial pressure 1869 Anti-vasospasm 源自1869年的医疗仁道实践 .external ventricular drainage Controlling the blood pressure .Symptomatic treatment
１.medical •Lying in bed for more than 4 weeks •Avoiding agitation or excertion •haemostatic •Dehydration to reduce intracranial pressure •Anti-vasospasm •external ventricular drainage •Controlling the blood pressure •Symptomatic treatment
2. surgical history: 1885, Horsley ligation of internal carotid a 1927 cerebral angiography 1931 encapsulate the aneurysms with muscles 1869 1937 aneurysm clipping( by Dandy and trapping 源自1869年的医疗仁道实践 1942 ligation of the neck of the aneurysms Purpose of the operation avoiding re-rupture and re bleeding, keep the aneurysm-bearing arteries open and controlling vasospasm .Operation: direct--clipping, ligation or trapping Indirect: ligation of carotid artery or blocking the aneurysm-bearing atery Trapping(preoperative tests
２.surgical •history：1885,Horsley ligation of internal carotid a. 1927 cerebral angiography 1931 encapsulate the aneurysms with muscles 1937 aneurysm clipping ( by Dandy) and trapping 1942 ligation of the neck of the aneurysms •Purpose of the operation：avoiding re-rupture and rebleeding, keep the aneurysm-bearing arteries open and controlling vasospasm •Operation: direct—clipping, ligation or trapping Indirect: ligation of carotid artery or blocking the aneurysm-bearing atery Trapping (preoperative tests)
indication Hunt- Hess scale:I-Ⅲ Hunt-Hess scale IV-V should be operated when the 1869 patients recover to I-III 源自1869年的医疗仁道实践 In acute phase: with intracerebral hemorrhage or large volume of sah Infectious aneurysm
indication • age＜75； • Hunt-Hess scale: I－ III • Hunt-Hess scale IV-V should be operated when the patientsrecover to I-III • In acute phase: with intracerebral hemorrhage or large volume of SAH • Infectious aneurysm
peration time Immediate operation for Hunt-Hess I-II Patients with recurrent bleeding 1869 Patients with vasospasm should be operated on after 14-21 days from the initial bleeding 源自1869年的医疗仁道实践 Patient >50 years should avoid operation with in I week from the last bleeding Patients with giant aneurysms. wide base aneurysms should wait for the retraction of the brain edema. for the operations are difficult
Operation time • Immediate operation for Hunt-Hess I -II ； • Patients with recurrent bleeding； • Patients with vasospasm should be operated on after 14-21 days from the initial bleeding; • Patient >50 years should avoid operation with in 1 week from the last bleeding； • Patients with giant aneurysms, wide base aneurysms should wait for the retraction of the brain edema, for the operations are difficult