微骨窗入路在颅内动脉瘤手术中的应用  

Application of keyhole approach in operation of intracranial aneurysms

作　　者：周毅[1] 敖祥生[1] 黄星[1] 胡克琦[1] 刘汉东[1] 张青松[1] 徐廷伟[1] 陈彬[1] 蔡利[1] 郑玉远[1] 李朝显[1] 

机构地区：[1]华中科技大学同济医学院附属襄樊医院神经外科,441021

出　　处：《中华医学杂志》2005年第32期2250-2253,共4页National Medical Journal of China

摘　　要：目的探讨微骨窗入路(锁孔入路)治疗颅内动脉瘤的手术技术和治疗效果。方法采用微骨窗入路对56例58个颅内动脉瘤施行直接手术夹闭。56例动脉瘤中前交通动脉瘤23例,颈内后交通动脉瘤29例(双侧动脉瘤2例),颈内动脉瘤4例。手术经眶上入路22例,翼点入路18例,眉弓切口经眶入路16例。对33例患者使用神经内镜辅助手术。结果对56例动脉瘤的手术,成功地夹闭58个动脉瘤。对2例双侧后交通动脉瘤均经一侧入路一次夹闭。术后37例患者经复查脑血管造影,证实动脉瘤消失。无手术死亡病例。未发生与手术入路相关的并发症。结论微骨窗入路开颅治疗颅内动脉瘤在技术上是可行的。不仅减少了手术创伤,缩短了手术时间,治疗效果也理想。Objective To explore the operative technique and evaluate the effect of intracranial aneurysms via keyhole approach. Methods Fifty-six intracranial aneurysm patients, 23 with anterior communicating artery （AcomA） aneurysm, 29 with posterior communicating artery （PcomA） aneurysm, and 4 with internal carotid artery-posterior communicating artery aneurysm, totally with 58 lesions, were treated by microsurgery, via supraorbital keyhole approach in 22 cases, pterional approach in 18, and transorbital approach in 16. Adjuvant endoscopy was used in 33 patients. Results Fifty-eight lesions of aneurysm were clipped in all the patients and no one died. No approach-related severe complication occurred. Bilateral PcomA aneurysms in 2 cases were clipped via unilateral keyhole approach. Conclusion It is workable to treat intracranial aneurysms via keyhole approach. Keyhole approach not only reduces the operation-related trauma and shorten the operation time, but also obtains ideal results.

关 键 词：外科手术 最小侵入性 颅内动脉瘤 显微外科手术 微骨窗入路 手术中 神经内镜辅助手术 后交通动脉瘤 颈内动脉瘤 治疗效果 

分 类 号：R651.12[医药卫生—外科学]