硬膜外途径磨除前床突在后交通动脉动脉瘤夹闭术中的应用效果分析

Application effect analysis of anterior clinoid process drilled off via epidural approach in posterior communicating artery aneurysm clipping

目的探讨经硬膜外途径磨除前床突在后交通动脉动脉瘤(PCoAA)夹闭术中的应用效果。方法回顾性分析2012年1月—2014年1月开颅手术的42例PCoAA患者的临床资料,其中22例磨除前床突,20例未磨除前床突,分析术中夹闭动脉瘤难易程度及术后疗效。结果在22例磨除前床突术中,动脉瘤均得到满意夹闭,术中均未使用脑牵开器,术后仅有1例出现脑梗死,无动眼神经麻痹病例,无动脉瘤夹闭不全病例。20例未磨除前床突病例中,3例瘤夹置入困难造成动脉瘤夹闭不全,2例出现脑梗死,1例出现动眼神经麻痹。结论经硬膜外途径磨除前床突给PCoAA夹闭手术带来便利,术中能有效避免瘤夹置入困难,应用安全,降低术后并发症。

Objective To investigate the application ettect of anterior clinoid process drilled oii via epidural approach in posterior communicating artery aneurysm （PCoAA） clipping. Methods The clinical data of 42 patients with PCoAA who underwent craniotomy from January 2012 to January 2014 were analyzed retrospectively, including 22 patients performed anterior clinoid process drilled off and 20 did not. The difficult or easy degree of intraoperative aneurysm dipping and postoperative efficacy were analyzed. Results The aneurysms in 22 patients underwent anterior elinoid process were clipped satisfactorily. The brain retractor was not used during the procedure. Only one patient had cerebral infarction after procedure. No patients had oculomotor nerve paralysis and incomplete clipping of aneurysms. Of the 20 patients without the anterior clinoid process drilled off, 3 aneurysms were clipped incompletely because it was difficult to implant aneurysm clips, 2 had cerebral infarction, and 1 had oculomotor nerve paralysis. Conclusion Removing the anterior clinoid process drilled off via extradural approach may bring convenience for PCoAA dipping. It can effectively avoid the difficulty of implanting aneurysm clips during the procedure. Its application is safe and can reduce postoperative complications.