前交通动脉动脉瘤分型与手术入路选择  

Classification of anterior communicating artery aneurysms and selection of surgical approach to them

作　　者：黄传平[1] 林煜[1] 赖裕通[1] 汪先兵[1] 刘剑[1] 

机构地区：[1]解放军第421医院神经外科,广州510318

出　　处：《中国临床神经外科杂志》2014年第11期648-650,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨前交通动脉瘤的分型及其在两种手术入路选择中的价值。方法根据术前DSA和/或CTA,以前交通动脉及双侧大脑前动脉A2段为参考平面,将前交通动脉动脉瘤分为Ⅰ~Ⅴ型：Ⅰ型,瘤体朝前;Ⅱ型,瘤体朝下;Ⅲ型,瘤体朝后;Ⅳ型,瘤体朝上;Ⅴ型,瘤体多朝向。从2012年1月至2014年5月采用显微手术夹闭前交通动脉动脉瘤52例,采取翼点入路28例,其中Ⅰ型动脉瘤8例,Ⅱ型9例,Ⅲ型3例,Ⅳ型7例、Ⅴ型1例;前纵裂入路24例,其中Ⅰ型5例,Ⅱ型7例,Ⅲ型2例,Ⅳ型10例。结果本组52例均一次性夹闭瘤体,1例夹闭后包裹,其余均夹闭满意。出院时GOS评分4~5分37例,2~3分13例,1分2例。结论Ⅰ型、Ⅱ型两种入路均适合选择,可依个人习惯选择;Ⅲ、Ⅳ、Ⅴ型选择纵裂入路更合适。Objective To explore the classification of the anterior communicating artery（ACo A） aneurysms and surgical approachto them.MethodsAccording to the characteristic of ACo A aneurysms on the preoperative DSA and/or CTA imagings 52 cases of theACo A aneurysms were divided into 5 types, i.e. type Ⅰ aneurysm（aneurismal body pointing forwards）, 13 cases; type Ⅱ（aneurismalbody pointing downwards）, 16 cases; type Ⅲ（aneurismal body pointing backwards）, 5 cases; type Ⅳ（aneurismal body pointingupwards）, 17 cases and type Ⅴ（aneurismal body pointing toward the multi-directions）, 1 case. Of 52 patients with ACo A aneurysms, 28 underwent microsurgery through pterional approach and 24 through the anterior interhemisperic approach. Of 28 aneurysms which wereclipped by the microsurgery through pterional approach, 8 belonged in type Ⅰ aneurysm, 9 in type Ⅱ, 3 in type Ⅲ, 7 in type Ⅳ and 1 intype Ⅴ. Of 24 aneurysms which were clipped by the microsurgery through anterior interhemispheric approach, 5 belonged in type Ⅰaneurysm, 7 in type Ⅱ, 2 in type Ⅲ and 10 in type Ⅳ.ResultsOf 52 Aco A aneurysms, 51 were successfully clipped and 1 was clippedand wrapped. GOS ranged from 4 to 5 points in 37 patients, from 2 to 3 points in 13 and 2 died on discharge from hospital.Conclusions Both the pterional and anterior interhemispheric approaches which are proper for the microsurgery for types Ⅰ and Ⅱ aneurysms may beselected according to the operator habit. The microsurgery through the anterior interhemispheric approach is more proper for types Ⅲand Ⅳ aneurysms.

关 键 词：前交通动脉动脉瘤 分型 手术入路 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]