显微手术治疗前交通动脉动脉瘤(附115例报道)  

Microsurgery for anterior communicating artery aneurysms(report of 115 cases)

作　　者：王潞[1] 李俊[1] 陈文[1] 徐浩[1] 何苗[1] 幸标[1] 

机构地区：[1]武汉市中心医院神经外科,430010

出　　处：《中国临床神经外科杂志》2017年第5期299-301,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨前交通动脉动脉瘤显微手术治疗的临床效果。方法回顾性分析2009年1月至2016年1月显微手术治疗的115例前交通动脉动脉瘤的临床资料,术前均行3D-CTA(和/或)3D-DSA检查并模拟手术入路,经翼点入路施行动脉瘤夹闭。结果术后随访3个月~3年,按GOS评分评定预后,恢复良好89例,中残18例,重残4例,死亡4例。术后发生严重脑血管痉挛4例,行去骨瓣减压术,其中2例术后3月行颅骨修补术时,GOS评分5分;2例并发脑积水行脑室-腹腔分流术,6月后随访,1例GOS评分4分,1例3分。结论三维影像模拟手术入路可充分了解动脉瘤形态及穿支血管情况,采用翼点入路手术夹闭前交通动脉动脉瘤,可降低并发症发生率,提高病人生存质量。Objective To study the clinical effect of microsurgery on anterior communicating artery aneurysms. Methods The clinical data of 115 patients with anterior communicating artery aneurysms treated in Wuhan Municipal Central Hospital from January, 2009 to January, 2016 were analyzed retrospectively. 3D-CTA and （or） 3D-DSA was performed before the operation in all the patients, in whom the aneurysms were clipped by neurosurgery via pterional approach. 3D-simulated operations were performed in all the patients. The preoperative diagnosis, microsurgical aneurysm exposure technique, the prevention of the intraoperative complications and curative effects were analyzed. Results Of 115 patients with anterior communicating artery aneurysms, 27 belonged in Hunt-Hess grade I, 45 in the grade Ⅱ, 31 in the grade Ⅲ, 9 in the grade Ⅳ and 3 in the grade Ⅴ before the surgery. Postoperative follow-up period was from 3 months to 3 years. Of these 115 patients, 89 were recovered well, 18 moderately disabled, 4 severely disabled and 4 died according to GOS grading system. Conclusions The 3D-simulated operation is helpful to the preoperative understanding of aneurysm morphology and perforating vessels. The postoperative complications can be decreased and life quality can be enhanced by the microneurosurgery via the pterional approach in the patients with anterior communicating artery aneurysms.

关 键 词：颅内动脉瘤 前交通动脉 显微手术 翼点入路 疗效 

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]