目的探讨大脑中动脉瘤破裂伴颅内血肿的临床特征、显微手术技巧及临床疗效。方法回顾性分析18例大脑中动脉瘤破裂伴颅内血肿行显微神经外科治疗患者的临床资料,按Hunt-Hess分级:Ⅲ级8例,Ⅳ级7例,Ⅴ级3例,均经螺旋CT血管造影(CTA)确诊。结果动脉瘤夹闭17例,动脉瘤夹闭+包裹1例。依据格拉斯哥预后评分(GOS)判断:优良9例,轻残5例,重残2例,植物状态1例,死亡1例。结论大脑中动脉瘤破裂合并血肿的患者,病情多危重,应急诊开颅手术,清除血肿,尽早解除颅高压,减轻继发性脑损伤,同时夹闭动脉瘤,可有效预防致命的再出血,提高治疗效果。 Objective To investigate the clinical features, microsurgical skills and clinical efficacy of ruptured intracranial aneurysms with intracranial hematomas. Methods A retrospective analysis of 18 cases of cerebral aneurysm rupture with intracranial hematoma underwent microsurgical treatment of patients with clinical data, according to Hunt-Hess classification: Ⅲ grade in 8 cases, Ⅳ grade in 7 cases, Ⅴ grade in 3 cases, both by spiral CT angiography (CTA) confirmed. Results Aneurysm clipping in 17 cases, aneurysm clipping + wrapping in 1 case. According to Glasgow’s prognostic score (GOS), 9 cases were fine, 5 cases were mild disability, 2 cases were severe disability, 1 case was plant and 1 case died. Conclusions Patients with ruptured middle cerebral artery aneurysm complicated with hematoma are more critically ill. Emergency craniotomy, hematoma removal, as soon as possible to relieve intracranial hypertension, reduce secondary brain injury, while clamping the aneurysm, can effectively prevent fatal rebleeding, Improve the treatment effect.