神经内镜在颅内动脉瘤的外科手术中的应用  

Application of the neuro-endoscope to the intracranial aneurismal surgery

作　　者：赵继宗[1] 王硕[1] 王永刚[1] 赵元立[1] 于书卿[1] 王嵘[1] 王德江[1] 张东[1] 李勇[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050

出　　处：《中华医学杂志》2004年第10期799-802,共4页National Medical Journal of China

摘　　要：目的　讨论神经内镜在颅内动脉瘤外科的作用 ,分析其价值和缺点。方法　应用神经内镜配合显微镜手术夹闭颅内动脉瘤 88例 (89个动脉瘤 ) ,其中前循环系统动脉瘤 81例 (共 82个动脉瘤 ) ,后循环系统动脉瘤 7例。全部采用微骨孔入路。全部病例在动脉瘤夹闭前、后进行多普勒超声探测。其中神经内镜辅助显微神经外科手术 (EAM ) 84例 ,手术显微镜下夹闭动脉瘤后 ,神经内镜观察动脉瘤蒂结构、供血动脉分支和深部穿通支 ,并证实动脉瘤夹的位置。神经内镜控制显微神经外科手术 (ECM) 5例 ,在内镜下可清楚观察动脉瘤周围的解剖 ,观察到颈内动脉后方的后交通动脉、对侧前动脉。结果　 86例术后 2周复查数字减影血管造影 (DSA) ,均显示动脉瘤夹闭满意。无手术死亡 ,手术后并发症 7例 (7 95 % ) ,未出现与内镜有关并发症。结论　神经内镜适用于复杂性动脉瘤 ,内镜放大、照明和观察死角的作用 ,能更好观察局部解剖 ,可以更确切夹闭动脉瘤蒂 ,降低手术后并发症。Objective To study the role of neuro-endoscope in the intracranial aneurismal surgery,analyzing its benefits,and disadvantages. Methods Endoscopy was used as an adjunct in the microsurgical treatment of clipping aneurysms on 88 patients with 89 aneurysms,of which 82 aneurysms in 81 patients were located in the anterior circulation and 7 were located in the posterior circulation. Keyhole approach was performed on all patients,and micro-Doppler ultrasound technique was used before and after clipping. In 84 aneurysms,endoscope-assisted microneurosurgery (EAM) was used in addition to microsurgical dissection and clipping so as to observe the neck anatomic features and perforators and to verify the optimal clipping position. Endoscope-controlled microneurosurgery was used for 5 aneurysms to observe the anatomy around aneurysm,such as the posterior communicating artery and the opposite anterior communicating artery behind the internal carotid artery. Results Postoperative angiography performed on 86 patients showed satisfactory aneurysm clipping. Operative mortality was 0. There were 7 cases of postoperative complications,with an incidence rate of 7.95%,and none case was directly related to endoscopy. Conclusion Improving observation of regional anatomy because of its ability in magnification,illumination,and looking around dead angle,neuro-endoscopy is very useful for complex aneurysms.

关 键 词：神经内镜 颅内动脉瘤 外科手术 神经内镜 微骨孔入路 数字减影血管造影 

分 类 号：R739.4[医药卫生—肿瘤]