翼点入路开颅手术夹闭后内侧下型后交通动脉瘤的临床观察  

Clipping posterior communicating artery aneurysms of medial posterior inferior type by conventional pterional craniotomy:a clinical observation study

作　　者：刘峥 黄银兴 陈其钻 尚明超 王守森 张尚明 Liu Zheng;Huang Yinxing;Chen Qizuan;Shang Mingchao;Wang Shousen;Zhang Shangming(Department of Neurosurgery,900th Hospital of Joint Support Force of People's Liberation Army,Fuzhou 350025,China)

机构地区：[1]解放军联勤保障部队第九〇〇医院神经外科,福州350025

出　　处：《中华神经医学杂志》2021年第12期1225-1230,共6页Chinese Journal of Neuromedicine

摘　　要：目的探讨翼点入路开颅手术中后内侧下型(颈内动脉内侧后下方、被颈内动脉遮挡)破裂后交通动脉瘤的夹闭方法。方法﹐选择联勤保障部队第九〇〇医院神经外科自2004年1月至2020年1月行翼点入路开颅手术夹闭后内侧下型破裂后交通动脉瘤患者7例进入研究,回顾性分析患者的临床资料和疗效。结果夹闭手术中误夹脉络膜前动脉2例,其中1例释放动脉瘤夹后发现并松开调整,另外1例患者经过多次调整后避开;2例患者切除前颞叶脑组织约20 mm,5例患者采用脑压板向后方牵开前颞叶。术后复查CTA显示,7例患者的动脉瘤消失,未见瘤颈残留,载瘤动脉保持通畅。1例患者的脉络膜前动脉供血区脑梗死。7例患者随访1~6年,平均27.6个月。6例患者完全康复,无神经功能障碍。1例患者对侧肢体偏瘫,肌力Ⅲ级.拄拐行走,生活基本自理。结论翼点入路开颅手术夹闭后内侧下型破裂后交通动脉瘤时操作困难,可采取扩大周围脑池间隙等方法,利用直弯、弯形动脉瘤夹夹闭动脉瘤。Objective To investigate the clipping methods of ruptured posterior communicating artery(PCoA)aneurysms of medial posterior inferior type(aneurysms located at the medial posterior inferior part of internal carotid artery or occluded by the internal carotid artery)during conventional pterional craniotomy.Methods Seven patients with ruptured PCoA aneurysms,admitted to our hospital from January 2004 to January 2020,were chosen in our study.The clinical data and surgical efficacies of these patients were retrospectively analyzed.Results The anterior choroidal artery(AChA)was accidentally clipped in 2 patients during the surgery,of which one was released after adjustment and one was avoided after multiple adjustments.Due to severe acute brain swelling,the brain tissues of the anterior temporal lobe were removed for about 20 mm in 2 patients,and the anterior temporal lobe was retracted posteriorly by platens in 5 patients.All aneurysms disappeared in the postoperative CTA images,no residual neck was found,and the parent artery remained unobstructed.One patient had cerebral infarction in the AChA supplying area.All patients were followed up for 1-6 years,with an average of 27.6 months.Six patients recovered completely without neurological dysfunction.One patient had contralateral hemiplegia,with muscle strength grading III,walking on crutches,and basic living by himself.Conclusion It's difficult to clip the ruptured PCoA aneurysms of medial posterior inferior type by conventional pterional craniotomy;so straight and curved aneurysm clips can be used to clip aneurysms by expanding the inter-cisternal space around the aneurysms.

关 键 词：后交通动脉瘤 开颅夹闭 后交通动脉 脉络膜前动脉 

分 类 号：R651.12[医药卫生—外科学]