浙江大学医学院：脑血管疾病手术（PPT讲稿）Surgery for Cerebrovascular Diseases（CVDs）

Surgery for Cerebrovaseular Diseases(C yDs) 1869 源自1869年的医疗仁道实践 Jian-min Zhang Dept of Neurosurgery 2nd Affiliated Hospital Zhejiang University College of Medicine

Surgery for Cerebrovascular Diseases(CVDs) Jian-min Zhang Dept. of Neurosurgery 2nd Affiliated Hospital Zhejiang University College of Medicine

introduction Cerebral vascular diseases(CVDs)are series of diseases with high mortality which have loaded a heavy burden to 1869 the society Classification: Hemorrhagic and 源自1869年的医疗仁道实践 Occlusive Treatment: medicine and surgery With the development of basic science microneurosurgery and endovascular techniques, more and more CVDs can be treated by means of surgery

• Cerebral vascular diseases (CVDs) are series of diseases with high mortality, which have loaded a heavy burden to the society. • Classification ： Hemorrhagic and Occlusive • Treatment：medicine and surgery • With the development of basic science, microneurosurgery and endovascular techniques, more and more CVDs can be treated by means of surgery. introduction

1. Hemorrhagic CVD 1869 Intracranial aneurysm cerebral vascular malformation 源自1869年的医疗仁道实践 hypertensive hemorrhage

1. Hemorrhagic CVDs intracranial aneurysm cerebral vascular malformation hypertensive hemorrhage

(). intracranial aneurysm 1869 源自1869年的医疗仁道实践

(1). intracranial aneurysm

general knowledge incidence: 0.2-7.9% in autopsy: 6-8/105/year for ruptured aneurysms. It is the third common CVDs and the incidence is increasing 1869 Most common in 40-60 years old Morphology: abnormal dilation of intracraniaarteries- 源自1869年的医疗仁道实践 saccular, fusiform and dissecting Often diagnosed when ruptured and cause subarachnoid hemorrhage(SAH) Mortality decreased with the improvement of diagnose and management

general knowledge • incidence: 0.2-7.9% in autopsy; 6-8/105 /year for ruptured aneurysms. It is the third common CVDs and the incidence is increasing. • Most common in 40-60 years old • Morphology: abnormal dilation of intracraniaarteries- ---saccular, fusiform and dissecting • Often diagnosed when ruptured and cause subarachnoid hemorrhage(SAH). • Mortality decreased with the improvement of diagnose and management

Etiology Congenital Acquired 1869 Infectious 源自1869年的医疗仁道实践 Traumatic Caused by angiosclerosis Caused by dissecting of blood vessels

Etiology •Congenital •Acquired: Infectious Traumatic Caused by angiosclerosis Caused by disecting of blood vessels

Common Location anterior circulation: 85%95% anterior a. -30% 1869 posterior communicating a.-25% middle cerebral a. -20% 源自1869年的医疗仁道实践 e Posterior circulation: 5%15% basilar a-10% vertebrate a. -5%

Common Location •anterior circulation: 85%～95% anterior a. -30% posterior communicating a. -25% middle cerebral a. -20%； •Posterior circulation: 5% ～ 15% basilar a. -10%； vertebrate a. -5%

Risk factors °age 1869 o Genetic background . Homodynamic factors 源自1869年的医疗仁道实践 Defects in medial layer of blood vessels .Hypertension

Risk factors •age •Genetic background •Homodynamic factors •Defects in medial layer of blood vessels •Hypertension

Natural histol 1869 Ruptured: 7% die on the spot, 7% 源自1869年的医疗仁道实践 misdiagnosed Re-bleeding: peak at 7-10th days

Natural history •Ruptured :7% die on the spot,7% misdiagnosed •Re-bleeding: peak at 7-10th days

Pathology . SAH 1869 Intracranial hemorrhage .hydrocephalus 源自1869年的医疗仁道实践 cerebral vasospasm

Pathology •SAH •Intracranial hemorrhage •hydrocephalus •Cerebral vasospasm