What are the treatments and nursing measures for anterior communicating cerebral aneurysm?

What are the treatments for anterior communicating cerebral aneurysm? What are the nursing measures?

Surgical method:

① Aneurysm resection, end-to-end arterial anastomosis or vascular transplantation. Matas test is performed before carotid aneurysm surgery. Hypothermia anesthesia is used during the surgery to minimize the blood flow blockage time, or temporary inside-outside diversion is used to maintain blood perfusion of brain tissue.

② Endovascular repair of aneurysms: Suitable for patients with pseudoaneurysms or aneurysms that are tightly adhered to adjacent nerves and blood vessels.

③Aneurysm tangential resection and arterial repair. Suitable for saccular bulging aneurysms.

④ Aneurysm encapsulation: Suitable for patients whose aneurysms cannot be removed or who cannot tolerate resection.

⑤ Ligation of the proximal and distal arteries of the aneurysm, autologous venous bypass grafting in the anatomical position, and drainage of the aneurysm cavity. Suitable for infected aneurysms.

What are the nursing measures?

1. Control blood pressure

To prevent a sudden increase in intracranial pressure and blood pressure, measure and record blood pressure every hour to keep it stable. High blood pressure can cause rupture of blood vessels in the surgical area, so antihypertensive drugs can be used appropriately; low blood pressure can cause cerebral ischemia and cerebral infarction, so fluid replacement should be done in time. Since most patients have cerebral edema after surgery, blood pressure should be maintained at a normal to high level, that is, blood pressure should be controlled at 130-140/85-90 mmHg to facilitate cerebral blood perfusion.

2. Nursing of cerebral vasospasm

The incidence of postoperative cerebral vasospasm is 41% to 71%. Cerebral vasospasm can cause cerebral ischemia, followed by cerebral edema or cerebral infarction, resulting in death or disability.

Headache, impaired consciousness, progressive worsening of meningeal irritation signs, and persistent high fever all indicate possible cerebral vasospasm; if cerebral vasospasm has occurred, the "3H" therapy should be implemented immediately according to the doctor's advice: hypertension, hypervolemia, and high hemodilution; currently commonly used calcium ion blockers such as nemoton are dilator drugs, which need to be protected from light and maintained by intravenous micropumps. The infusion time is as long as 20 to 24 hours. Complications such as skin redness, sweating, and heart rate changes are common, and inspections need to be strengthened.