眶上外侧入路夹闭后循环动脉瘤七例并文献复习  

Lateral supraorbital approach for clipping posterior circulation aneurysms:report of seven cases and literature review

作　　者：仇尤佳 王紫兰 陈周青 顾枫 谈心 王世鑫 王伟[1] 朱昀[1] 王中[1] Qiu Youjia;Wang Zilan;Chen Zhouqing;Gu Feng;Tan Xin;Wang Shixin;Wang Wei;Zhu Yun;Wang Zhong(Department of Neurosurgery,the First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215006,China)

机构地区：[1]苏州大学附属第一医院神经外科,215006 [2]苏州市立医院神经内科

出　　处：《中国脑血管病杂志》2022年第1期43-50,共8页Chinese Journal of Cerebrovascular Diseases

基　　金：苏州市第五批姑苏卫生人才培养项目(GSWS2019002)。

摘　　要：目的探讨眶上外侧入路夹闭后循环动脉瘤患者的临床资料、影像学特征及手术疗效。方法回顾性连续纳入2015年12月至2021年1月就诊于苏州大学第一附属医院神经外科经眶上外侧入路夹闭的后循环动脉瘤患者。收集患者的一般及临床资料,包括年龄、性别、既往史、临床症状、Hunt-Hess分级量表,及影像学资料如动脉瘤部位、大小以及瘤颈宽度。术前使用Mimics 21.0医学影像控制系统三维重建动脉瘤及载瘤动脉,模拟眶上外侧入路开颅,测量动脉瘤两侧大脑后动脉分叉角度、动脉瘤直径以及动脉瘤颈与后床突的距离。术后即刻行CT或CT血管成像(CTA)检查评估动脉瘤是否完全夹闭并观察围手术期并发症发生情况。术后6个月通过门诊或电话方式对患者进行临床随访,采用格拉斯哥预后量表(GOS)评估预后,GOS评分1~3分为预后较差,4~5分为预后较好;影像随访采用门诊复查CTA,明确动脉瘤是否夹闭完全或复发。结果共纳入7例患者,其中基底动脉顶端动脉瘤5例、大脑后动脉瘤1例、小脑上动脉瘤1例,动脉瘤均高于后床突。所有患者动脉瘤经眶上外侧入路完全夹闭。术后4例患者出现并发症,其中肌力下降4例,动眼神经麻痹3例,脑梗死1例,肺部感染1例。术后6个月临床随访,GOS评分4~5分5例(预后较好),GOS评分3分2例(预后较差);门诊CTA复查均示动脉瘤夹闭完全,无复发。结论后循环动脉瘤手术复杂且并发症多,眶上外侧入路作为一种改良入路可尝试用来夹闭破裂及未破裂后循环动脉瘤,可能适用于高于后床突、Hunt-HessⅠ~Ⅲ级且位于鞍后的动脉瘤。Objective To explore the clinical data,imaging characteristics and surgical outcome of patients with posterior circulation aneurysms clipped by lateral supraorbital approach.Methods Patients with posterior circulation aneurysm who underwent aneurysm clipping via lateral supraorbital approach in the Department of Neurosurgery,the First Affiliated Hospital of Soochow University from December 2015 to January 2021 were retrospectively and consecutively enrolled.Patients clinical data including age,sex,clinical manifestation,past history,Hunt-Hess scale score,postoperative complication,follow-up data,and imaging data including position,size of the aneurysm and the width of the neck were collected.The Mimics 21.0(Materialise,Belgium)was applied to reconstruct the aneurysms and parent arteries,simulate craniotomy via lateral supraorbital approach and measure the angle of the bifurcation of the posterior cerebral artery,the diameter of aneurysms and the distance between the aneurysm neck and the posterior clinoid process.CT or CT angiography was performed immediately after the surgery to evaluate whether the aneurysm was completely clipped,and the occurrence of perioperative complication was observed.Six months after the surgery,patients were followed up via outpatient clinic or telephone.Prognosis was assessed by Glasgow outcome scale(GOS).GOS score of 1-3 points defined as poor outcome,and 4-5 points as good outcome.Imaging follow-up was performed by CT angiography to determine whether the aneurysm was clipped completely or relapsed.Results Seven patients were enrolled,including 5 cases of basilar bifurcation aneurysm,1 case of posterior cerebral artery aneurysm and 1 case of superior cerebellar artery aneurysm,all of which were above posterior clinoid process.Aneurysms in all patients were completely clipped via lateral supraorbital approach.Postoperative complications occurred in 4 patients,including 4 cases with muscle weakness,3 cases with oculomotor paralysis,1 case with cerebral infarction and 1 case with pulmona

关 键 词：颅内动脉瘤 基底动脉 后循环动脉瘤 眶上外侧入路 夹闭术 

分 类 号：R651.12[医药卫生—外科学]