目的探讨显微外科手术治疗颅内破裂微小动脉瘤的安全性和疗效。方法对73例DSA影像显示直径<5mm的颅内破裂动脉瘤患者的临床资料进行回顾性分析,总结颅内破裂微小动脉瘤的治疗策略,并分析早期显微外科手术的治疗效果。病例随访采用DSA(46例)或磁共振血管造影(11例),随访时间为术后3个月至4年。结果术前经DSA诊断的73例79个动脉瘤,经手术探查证实并给予处理的77个;未处理的2个动脉瘤中1个未予探查(多发性动脉瘤),另1个为A2段分支动脉瘤,术中未探查到。行手术处理的77个动脉瘤中单纯包裹术的有3个、单纯夹闭术的有59个、夹闭加包裹术的有12个、烧灼后包裹的有2个、行动脉瘤切除的有1个。术后格拉斯哥预后评分,5分的有59例,4分的有10例,3分的有2例,2分的有1例,1分的有1例。1例行包裹术的动脉瘤较前稍增大,2例夹闭术的动脉瘤颈部轻度复发,其余动脉瘤未见复发。结论显微外科手术治疗颅内破裂微小动脉瘤是一种安全、有效、可行的方法,对DSA不能证实,但具有明确动脉瘤破裂征象的自发性蛛网膜下腔出血可积极开颅探查。 Objective To investigate the safety and efficacy of microsurgery in the treatment of intracranial ruptured aneurysms. Methods The clinical data of 73 patients with ruptured intracranial rupture aneurysm whose diameter was less than 5 mm in DSA were retrospectively analyzed. The treatment strategy of intracranial ruptured aneurysm was summarized and the effect of early microsurgery was analyzed. The patients were followed up for DSA (46 cases) or magnetic resonance angiography (11 cases). The follow-up time ranged from 3 months to 4 years after operation. Results Totally 73 aneurysms diagnosed by DSA before surgery were confirmed by surgical exploration and 77 were treated. One of 2 untreated aneurysms was not detected (multiple aneurysms) and the other was A2 Segmental aneurysm, not detected during surgery. Surgical treatment of 77 aneurysms in simple wrapping of the three, 59 simple clipping, clipping and wrapping of 12, wrapped after the burning of 2, the aneurysm resection of 1 Postoperative Glasgow prognostic score, 59 cases of 5 points, 4 points in 10 cases, 3 points in 2 cases, 2 points in 1 case, 1 point in 1 case. A routine wound aneurysm compared with the former slightly increased, 2 cases of aneurysm neck clipping mild recurrence, the rest of the aneurysm no recurrence. Conclusion Microsurgical treatment of intracranial ruptured aneurysm is a safe, effective and feasible method, which can not be confirmed by DSA. However, spontaneous subarachnoid hemorrhage with definite signs of aneurysm rupture can be explored actively.