神经内镜辅助眶上锁孔入路早期夹闭前交通动脉瘤  

Endoscope-assisted supraorbital keyhole approach in early microsurgical clipping of anterior communicating artery aneurysm

作　　者：陈伟明[1] 曹作为[1] 金虎[1] 李钢[1] 史克珊[1] 陈焕雄[1] 陈晓东[1] 林鹏[1] 

机构地区：[1]中南大学湘雅医学院附属海口医院神经外科,海口570208

出　　处：《中华神经医学杂志》2011年第3期293-295,共3页Chinese Journal of Neuromedicine

摘　　要：目的 探讨应用神经内镜辅助眶上锁孔入路早期手术夹闭前交通动脉瘤的疗效。方法 中南大学湘雅医学院附属海口医院神经外科自2002年1月至2010年1月采用神经内镜辅助眶上锁孔入路在出血早期（72h内1手术治疗前交通动脉瘤（Hunt－Hess分级l～3级）患者35例，回顾性分析患者的临床资料和疗效。结果 35例患者均顺利完成动脉瘤夹闭。2例患者术中动脉瘤破裂，经临时阻断载瘤动脉快速解剖瘤颈后夹闭；患者均无人路相关的严重并发症：术后复查DSA或CTA证实动脉瘤夹闭完全，载瘤动脉无狭窄，远端动脉通畅良好。术后3个月复诊时，30例（85．7％）患者恢复良好（GOS评分4～5分），所有患者切口美容效果良好。结论 出血早期（72h内）经神经内镜辅助眶上锁孔人路手术处理Hunt—Hess分级Ⅰ～Ⅲ级前交通动脉瘤患者安全、有效。Objective To evaluate the effectiveness of the endoscope-assisted supraorbital keyhole approach in the early surgical treatment of patients with ruptured anterior communicating artery aneurysms （AcoA）. Methods Thirty-five patients with ruptured AcoA, admitted to our hospital from January 2002 to January 2010, adopted clipping via endoscope-assisted supraorbital keyhole approach within 72 h of onset. The neurostatus of these patients were ranged from grade 1 to 3 （Hunt-Hiss Scale scores）. The surgical details were described, and the clinical results were assessed according to the scores of Glasgow Outcome Scale. Results Operations were successfully finished in all patients; the endoscope-assisted supraorbital keyhole approach offered sufficient exposure of neurovascular structures for clipping AcoA. Intraoperative accidental aneurysm rupture occurred in 2 patients, but these events were managed successfully by blocking-up the parent artery and performing quick aneurysm neck dissection; no serious complications caused by the surgical approach occurred; postoperative DSA or CTA indicated that the aneurysm was totally clipped and the parent artery appeared no stenosis, and distal artery was unobstructed. Three months after the operation, 30 patients （85.7%） achieved very good outcomes （GOS： 4-5 scores）. All the patients achieved good cosmetic results. Conclusion In selected AcoA patients with grade 1-3, the endoscope-assisted supraorhital keyhole approach is safe and effective for gaining access to and treating the aneurysms on early hemorrhage stage.

关 键 词：颅内动脉瘤 眶上锁孔入路 神经内镜 

分 类 号：R739.4[医药卫生—肿瘤]