Non-surgical treatment to prevent rebleeding after ruptured intracranial aneurysm (1): including absolute bed rest, analgesia, antiepileptic drugs, sedatives and cathartics to keep patients quiet and avoid emotional excitement. Anti-fibrinolytic agents (aminocaproic acid, anticoagulant acid, phthalase inhibitor, etc.). ) is used. Before the treatment of aneurysm, controlling blood pressure is one of the important measures to prevent and reduce the rebleeding of aneurysm, but too low blood pressure will lead to insufficient cerebral perfusion and damage. Generally, 10% ~ 20% can be reduced.

(2) Reduce intracranial pressure: Intracranial pressure may increase after subarachnoid hemorrhage, so mannitol can be used. However, the application of mannitol will increase the blood volume, increase the average blood pressure and occasionally rupture the aneurysm.

(3) Cerebrospinal fluid drainage: In the acute stage after aneurysm hemorrhage, a large amount of hematocele can appear on the brain surface and brain to increase intracranial pressure, and some patients may have consciousness disorder due to small hematoma or blood clot blocking the interventricular foramen or cerebral aqueduct, resulting in acute hydrocephalus, which requires emergency ventricular drainage. Lumbar puncture and lumbar cistern drainage can also be used as cerebrospinal fluid drainage methods, but in the state of high intracranial pressure, it may cause brain hernia crisis in patients.

(4) Prevention and treatment of cerebral vasospasm: After aneurysm rupture and bleeding, blood entering subarachnoid space can easily lead to cerebral vasospasm. Cerebral vasospasm began to appear 3 ~ 4 days after bleeding, peaked at 7 ~ 10, and began to subside at 10 ~ 14 days. At present, the treatment of cerebral vasospasm mainly focuses on three aspects: the application of calcium antagonists; Removing bloody cerebrospinal fluid; Blood pressure rises normally.

Surgical treatment of intracranial aneurysms The surgical treatment of aneurysms includes craniotomy and endovascular interventional therapy.

(1) Neck clipping or ligation of aneurysm: The purpose of operation is to block the blood supply of aneurysm and avoid rebleeding; Keep the tumor-bearing artery and blood supply artery unobstructed, and maintain the normal blood supply of brain tissue.

(2) Aneurysm isolation: Aneurysm isolation is to clamp the parent artery at the distal and proximal ends of the tumor at the same time, so that the aneurysm can be separated from blood circulation.

(3) Aneurysm wrapping: Using different materials to reinforce the aneurysm wall can reduce the chance of rupture, although the aneurysm cavity is still congested. At present, there are fascia and cotton silk in clinical application.

(4) Endovascular interventional therapy: For patients with aneurysms, the risk of craniotomy is extremely high, and the craniotomy fails, or because the whole body and local conditions are not suitable for craniotomy, intravascular embolization can be used. For aneurysms that do not meet the above conditions, embolization can also be the first choice. The purpose of endovascular interventional therapy is to use femoral artery puncture to place a slender microcatheter in the aneurysm sac or tumor neck, and then send the soft titanium alloy spring coil into the aneurysm sac through the microcatheter to fill it up, so that the blood flow in the aneurysm sac disappears, thus eliminating the risk of bleeding again. [2-3]