大脑前动脉A1段动脉瘤的手术处理  

Surgical management of proximal anterior cerebral artery(A1) aneurysms

作　　者：王华伟[1] 薛哲[1] 马玉栋[1] 王文鑫[1] 武琛[1] 孙正辉[1,2] 

机构地区：[1]解放军总医院神经外科,北京100853 [2]解放军总医院海南分院神经外科,海南三亚572013

出　　处：《南方医科大学学报》2016年第11期1521-1526,共6页Journal of Southern Medical University

摘　　要：目的回顾性分析手术治疗的23例大脑前动脉近端（A1段）动脉瘤患者的病例资料,探讨手术治疗的技巧和方法。方法2004年1月-2014年12月期间共手术治疗1437例颅内动脉瘤,选择其中A1段动脉瘤23例（1.6%）,所有患者术前均经数字减影血管造影术（DSA）或CT血管造影（CTA）明确诊断,并行手术夹闭治疗颅内A1段动脉瘤,术后行＂3H＂疗法预防血管痉挛,于术后第6、12、48、60个月门诊随访,行CT血管造影（CTA）复查,并使用Glasgow预后分级（GOS）评价术后疗效。结果所有A1动脉瘤均采取翼点入路开颅手术完全夹闭;有7名（30.43%）患者为多发动脉瘤;术后平均随访时间38.52（6-60）个月,平均Glasgow预后分级为4.83分（Ⅲ-Ⅴ级）。结论术前仔细分析影像资料对于其诊断和治疗至关重要。手术治疗的关键是保护穿支动脉不受损伤,术中充分打开侧裂并进行载瘤动脉临时阻断可使手术安全、有效。Objective To review our experience in surgical management of proximal anterior cerebral artery（A1） aneurysms in23 patients. Methods Between January, 2004 and December, 2014, 23 patients（1.6%） with A1 aneurysms diagnosed by CTA or DSA were treated surgically. The＂3H＂therapy was adopted for postoperative prevention of cerebrovascular spasm. All the patients were followed up and examined with cerebrovascular CTA at 6, 12, 48 and 60 months after the operation with their Glasgow Outcome Scale score recorded. Results The patients consisted of 15 men and 8 women with an age range of 16 to 72years（mean 51.3 years）. The average diameter of the aneurysms was 5.8 mm, ranging from 3.2 to 9.7 mm. Twenty-two saccular aneurysms were found in these patients; 21 patients presented with SAH and two had vascular malformation. All the A1 aneurysms were managed through the pterional approach, and the mean postoperative Glasgow Outcome Scale score was 4.8.Conclusion Thorough analysis of the angiographic data is essential for the diagnosis and treatment of A1 aneurysms.Preservation of the perforators and prevention of aneurysm rupture are critical during the surgery. Full exposure of the Sylvian fissure and temporary occlusion of the parent artery ensures safe and effective dissection of A1 aneurysms.

关 键 词：大脑前动脉 动脉瘤 显微手术 

分 类 号：R651.12[医药卫生—外科学]