单侧人路夹闭颅内双侧多发性动脉瘤  

Unilateral approach to clip bilateral multiple intracranial aneurysms

作　　者：洪涛[1] 汪阳[1] 

机构地区：[1]南昌大学第一附属医院神经外科,330006

出　　处：《中华神经外科杂志》2007年第11期816-818,共3页Chinese Journal of Neurosurgery

摘　　要：目的探讨单侧入路夹闭双侧多发颅内动脉瘤的手术方法。方法自2005年9月至2006年12月共收治12例颅内双侧多发性动脉瘤,其中8例采取了单侧入路治疗双侧颅内动脉瘤。病人均为Hunt-Hess分级Ⅲ级以下,以双侧后交通动脉瘤最常见。采用单侧翼点入路,夹闭本侧动脉瘤后,继续分离对侧各间隙,直至显露对侧动脉瘤颈及载瘤动脉的近、远心段。结果成功夹闭8例共19个动脉瘤,术后6例DSA复查均示双侧多发性动脉瘤消失,载瘤血管通畅。本组无死亡。结论单侧入路夹闭双侧多发动脉瘤具有损伤小、手术时间短,避免了二次手术的优点。缺点是操作空间较狭小、位置深在,技术要求高,适合有较丰富显微外科经验者选用。Objective To review the technique of unilateral approach to bilateral multiple intracranial aneurysms. Method From September 2005 to December 2006, 8 cases of 12 patients with bilateral multiple intracranial aneurysms were unilaterally approached. All patients collected were under Ⅲ grades according to Hunt-Hess clarification. Bilateral posterior communicating aneurysms were the common type in our group. Unilateral pterional approach was adopted. After routinely clipping the ipsilateral aneurysm, dissection to opposite spaces was continued until the exposure of the neck of contralateral aneurysm and the proximal contralateral carotid artery for vascular control. Result Total 19 aneurysms in 8 patients were successfully clipped. The parent arteries were preserved in all cases, particularly the fetal posterior communicating arteries. There was no death associated with this approach in our group. Conclusion The advantage of the technique is obvious, e.g. the ability to spare the patient from risk and inconvenience associated with a separate eraniotomy at the same or different stage. The disadvantage of the technique is that the space of manipulation is deep and narrow. Therefore, it is an alternative approach only for experienced neurosurgeons.

关 键 词：颅内动脉瘤 多发性 显微外科手术 单侧入路 

分 类 号：R651.12[医药卫生—外科学]