经翼点入路前交通动脉瘤的显微手术治疗（附398例报告）  

Microsurgical dipping by pterional approach for an anterior communicating artery aneurysm

作　　者：高宝山[1] 孙丕通[1] 张健[2] 许友松[2] 徐英辉[2] 段云平[1] 邓东风[1] 常庆勇[1] 刘荣耀[2] 廉志刚[2] 卢军[2] 白景阳[2] 

机构地区：[1]大连大学附属中山医院神经外科,116001 [2]大连医科大学附属医院神经外科

出　　处：《中华神经外科杂志》2009年第7期630-632,共3页Chinese Journal of Neurosurgery

摘　　要：目的总结经翼点入路显微手术夹闭前交通动脉瘤的优缺点。方法对398例前交通动脉瘤采用经翼点入路直接夹闭术的结果进行回顾性分析。由于双侧Al段常发育异常及相应的前交通动脉的血流方向的个体差异，动脉瘤的形态变化及生长方向不同，手术入路的定侧与难度亦有所不同。结果本组病例中6例（Hunt—Hess1V级2例，V级4例）由于严重脑血管痉挛等并发症，分别于术后3d至3周内死亡。随诊时间为3个月至22年不等，短期内全组病人均获得随诊，但长期随诊者为295例，97例失访。随访的病人中I、Ⅱ级214例（72％）均恢复正常工作，Ⅲ级者42例（14％）恢复正常工作，23例（7．7％）生活自理，3例（1％）不能生活自理。Ⅳ级者中有4例（1．3％）恢复正常工作；V级中有1例恢复正常工作，1例不能生活自理。结论经翼点入路直接显微手术，是治疗前交通动脉瘤较为理想的方法。手术前仔细阅片，了解前交通动脉区的血管关系及血流变化，对于手术入路选择至关重要。Objective To analyse the advantages of the pterional approach to an anterior communicating artery aneurysnr Method 398 cases of an anterior communicating aneurysm were clipping treated by the pterional approach, The site of an aneurysmal neck and the direction of growing projection mustbe classified accurately from the preoperative angiography. Results 6 of cases died of serious vasospasm ; During 3months -22years ,295 cases were followed up ,all of cases with Hunt -hess 1 and 2 were good（72% ）, 42 of cases with 3 recovered（ 14% ） ,4 of cases with 4 returned to normal（ 1. 3% ） ,one ease recovered and one disabled in the group with 5. Condusions Although a pterional approach to an anterior communicating artery anrurysm is an excellent accessing method,it should be emphasized the preoperative evaluation the aneurysmal neck, position, direction, relation of vaseulars around anterior communicating artery aneurysm and anomalies.

关 键 词：颅内动脉瘤 脑血管造影术 翼点入路 前交通动脉 

分 类 号：R686[医药卫生—骨科学]