显微手术治疗大脑中动脉分叉部动脉瘤  

Microsurgical treatment for middle cerebral artery bifurcation aneurysms

作　　者：王洪生[1] 杨昭伟[1] 徐新文[1] 王辉[1] 赵佩林[1] 王阳春[1] 

机构地区：[1]解放军第二五一医院神经外科,张家口075000

出　　处：《临床神经外科杂志》2011年第3期153-156,共4页Journal of Clinical Neurosurgery

摘　　要：目的探讨大脑中动脉(MCA)分叉部动脉瘤的解剖特点、临床特征、影像学表现、显微手术技巧及临床疗效。方法回顾分析41例MCA分叉部动脉瘤显微外科治疗患者的临床资料,39例有动脉瘤破裂出血的临床表现,按Hunt-FHess分级:0～Ⅰ级5例,Ⅱ级15例,Ⅲ级11例,Ⅳ级9例,Ⅴ级1例。64排螺旋CT血管造影(CTA)确诊。41例均行显微手术治疗,手术入路为翼点入路或扩大翼点入路。对多发动脉瘤采取早期与择期、一期与分期相结合的方法处理动脉瘤,原则是先处理破裂动脉瘤,再处理未破裂动脉瘤。结果动脉瘤夹闭38例,动脉瘤夹闭+包裹2例,夹闭一侧动脉瘤,另一侧动脉瘤未处理1例。依据GOS判断:优良31例,轻残6例,重残2例,死亡2例。结论显微外科手术治疗MCA分叉部动脉瘤效果显著。熟悉MCA分叉部动脉瘤的解剖特征有助于减少术中血管损伤和术后神经功能障碍;对合并脑内血肿的MCA分叉部动脉瘤,应急诊手术清除血肿并夹闭动脉瘤。Objective To explore the regional surgical anatomy, clinical characteristics, neuroradiological manifestation, microsurgical skill and clinical effectiveness of middle cerebral artery （MCA） bifurcation aneurysms. Methods The clinical data of 41 patients with MCA bifurcation aneurysms treated by microsurgieal operation in our hospital were analyzed restrospectively, of whom 39 patients presented with clinical manifestations of aneurysmal rupture. According to Hunt-Hess classification, 5 belonged in grade 0 - I , 15 in grade ]I , 11 in grade Ill, 9 in grade IVand 1 in grade V. All patients were made a definite diagnosis by 64 rows helical CT angiography （CTA）. 41 patients were performed micorsurgical management through operation of transpterional approach or extended transpterional approach. The multiple intracranial aneurysms were treated through the method of combining early-stage with select-stage operation and one-stage with two-stage operation, the operating principle was the ruptured aneurysm been treated firstly and the unruptured aneurysm been treated secondly. Results Clipping was carrying out in 36 cases, clipping plus wrapping in 4, clipping in one side aneurysm and another side one did not treat in 1. Surgical outcome were good in 31 cases, light disability in 6, severe disability in 2 and 2 in dead. Conclusion The surgical outcome are predominance that MCA bifurcation aneurysms are performed microsurgical operation. The regional surgical anatomy of MCA bifurcation aneurysms should be clearly borne in mind in order to avoid the damage to the arteries and postoperative neurological deficits. Emergency hematoma evacuation and aneurysms clipping should be performed in the patients with intracerebral hematoma due to aneurysm rupture.

关 键 词：大脑中动脉 动脉瘤 显微手术 预后 

分 类 号：R651.12[医药卫生—外科学]