神经内镜在颅内动脉瘤夹闭术中的应用  

Application of neuroendoscope in microsurgical clipping to the intracranial aneurysm

作　　者：李江安[1] 鲁晓杰[1] 李兵[1] 钱硕[1] 丁鸭锁[1] 徐嘉[1] 

机构地区：[1]南京医科大学附属无锡第二医院神经外科,214002

出　　处：《中华神经外科杂志》2014年第5期481-484,共4页Chinese Journal of Neurosurgery

摘　　要：目的结合作者多年神经内镜应用经验和体会，探讨神经内镜在颅内动脉瘤夹闭术中的应用价值。方法回顾性分析87例神经内镜辅助下的颅内动脉瘤显微夹闭术。包括85例前循环动脉瘤，2例基底动脉顶端动脉瘤。18例在夹闭前置入内镜，87例均在夹闭后置入内镜观察。主要目的是多角度观察载瘤动脉、瘤颈及瘤周穿通支，以确定最佳夹闭位置和程度。结果77例术后2周内复查CTA，23例3个月后复查DSA，均显示动脉瘤夹闭满意。19例经内镜发现夹闭不佳而调整动脉瘤夹，1例颈内一后交通动脉动脉瘤在内镜下上第2枚动脉瘤夹。未出现与使用神经内镜有关的并发症。结论神经内镜局部放大、良好照明及其广角和成角的特点，在颅内动脉瘤夹闭过程中能有效弥补显微镜的不足，更好地观察动脉瘤及其周围的局部解剖结构，提高动脉瘤夹闭手术的质量，降低术后并发症。Objective To explore the value of neuroendoscope in the intracranial aneurysm surgery. Methods To study 87 cases with aneurysms, treated between Janurary 2007 and September 2012, for whom the endoscope were used to assist the microsurgical treatment, of which 85 aneurysms were located in the anterior circulation and 2 were located in the basilar tip. the endoscope was used in 18 cases before clipping and in 87 cases after clipping to observe the anatomic features of necks and perforators, and to verify the optimal clipping position. Results Postoperative computed tomography angiography in 77 patients and digital subtraction angiography in 23 patients performed showed satisfactory aneurysm clipping. The clip was repositioned in ninteen aneurysm operations, and the second clip was used inl case by endoscope. None case hadpostoperative complications directly related to endoscopy. Conclusions Endoscope is very useful during cerebral aneurysm surgery because of its ability in magnification, illumination, wide-angel and angulation. It can provide valuable information by better observation of regional anatomic features around aneurysm and improve the quality of aneurysm surgery.

关 键 词：神经内镜 颅内动脉瘤 夹闭术 

分 类 号：R651.1[医药卫生—外科学]