眶外侧锁孔入路治疗不同瘤颈起源的破裂颈内动脉分叉部动脉瘤的影像及手术特点  

Imaging and surgical characteristics of lateral orbital keyhole approach in treatment of ruptured internal carotid artery bifurcation aneurysms originated from different aneurysmal necks

作　　者：罗煜宸 张洪伟 刘希光 LUO Yuchen;ZHANG Hongwei;LIU Xiguang(Department of Neurosurgery,Lianyungang Clinical Medical College of Nanjing Medical University,Lianyungang 222002,China;Department of Neurosurgery,Affiliated Lianyungang Hospital of Xuzhou Medical University,Lianyungang 222023,China)

机构地区：[1]南京医科大学连云港临床医学院神经外科,连云港222002 [2]徐州医科大学附属连云港医院神经外科,连云港222023

出　　处：《中华显微外科杂志》2024年第6期641-646,共6页Chinese Journal of Microsurgery

摘　　要：目的分析眶外侧锁孔(LOK)入路治疗不同瘤颈起源的破裂颈内动脉分叉部动脉瘤(ICABifAs)的影像及手术要点,为临床治疗提供指导。方法本文为回顾性研究。自2017年1月至2023年6月,南京医科大学连云港临床医学院神经外科诊治23例ICABifAs患者,均采用LOK入路开颅夹闭治疗。根据不同瘤颈的起源,将动脉瘤分为A1型、M1型和ICA型,并在CTA三维成像上测量出A1(M1)与ICA的夹角和管径比,并进行相关性分析。术后2周、1个月、3个月、6个月回院门诊复诊,复查头颅CT、CTA或DSA以及基本体格检查。手术预后以格拉斯哥预后评分(GOS)来评价。应用Microsoft Excel以及SPSS 27.0统计学软件对数据进行统计分析,A1、M1、ICA末端的直径与ICA的夹角及瘤颈的直径采用配对样本t检验,用相关性分析来探究它们之间的关系,P<0.05为差异有统计学意义。结果本研究中A1型共12例(52.2%),M1型1例(4.3%),ICA型10例(43.5%)。A1的直径及与ICA的夹角均小于M1。A1与ICA夹角和M1与ICA夹角存在正相关,A1与ICA夹角与A1型动脉瘤直径存在负相关。本研究共23例破裂的ICABifAs均成功夹闭。1例患者术侧上睑下垂,出院后3个月随访时恢复正常(GOS 5分);1例术前Hunt-Hess分级Ⅳ级患者术后对侧肢体偏瘫(上肢肌力Ⅰ级,下肢肌力Ⅱ级),术后6个月随访GOS 3分(对侧上肢力Ⅱ级,下肢肌力Ⅲ级);1例患者术后对侧肢体活动障碍(上肢肌力Ⅲ级,下肢肌力Ⅳ级),术后6个月随访GOS 5分;1例术前Fisher分级Ⅳ级患者术后2个月继发脑积水,术后6个月随访GOS 4分;其余20例患者术后预后良好。结论ICABifAs中A1型最多见,ICA型稍少,M1型最少见;A1与ICA的夹角和M1与ICA的夹角正相关,与A1型动脉瘤直径负相关。经LOK入路治疗破裂的ICABifAs是可行且有效的微创方法。Objective To analyze the characteristics of medical imaging and surgical procedure of the lateral orbital keyhole(LOK)approach in treatment of ruptured internal carotid artery bifurcation aneurysms(ICABifAs)originated from different aneurysmal necks,therefore to provide a clinical guidance for the treatment.Methods A retrospective analysis was carried out based on the clinical data and pre-,intra-and post-operative images of 23 patients with ICABifAs that were diagnosed and treated in the Department of Neurosurgery,Lianyungang Clinical Medical College of Nanjing Medical University from January 2017 to June 2023.All patients were treated with craniotomy and clipping through the LOK approach.According to different origins,the aneurysmal necks were divided into type A1(A1),type M1(M1)and type ICA(ICA).Ratios of angle and diameter between A1(M1)and ICA were measured on 3D CTA images,and the correlation analysis was performed.Postoperative follow-ups were conducted at 2 weeks and 1,3,and 6 months after surgery,together with reviews of head CT,CTA or DSA and physical examinations.The surgical outcomes were evaluated by Glasgow Outcome Scale(GOS).Microsoft Excel and SPSS 27.0 statistical software were used to analyse the data.The diameter of the end of A1,M1,ICA and the angle between ICA,the diameter of tumor neck,and the paired sample t-test were used to analyse the size differences,and correlation analysis was used to explore the relationships with them.P<0.05 was considered a statistically significant different.Results In this study,12 patients(52.2%)were found with A1 aneurysmal neck,1(4.3%)with M1 and 10(43.5%)with ICA.The diameter of A1 and the angle between A1 and ICA were found both smaller than those of M1.The angle between A1 and ICA was positively correlated with the angle between M1 and ICA.The angle between A1 and ICA was negatively correlated with the diameter of A1 aneurysms.All of 23 patients of ICABifAs were successfully clipped.One patient had a ptosis on the operated side and returned to normal(GOS=5)

关 键 词：颅内动脉瘤 眶外侧锁孔入路 颈内动脉分叉部 神经显微手术 医学影像学 

分 类 号：R651.12[医药卫生—外科学]