一侧入路显露两侧脑动脉瘤的显微解剖研究

Unilateral approaches to bilateral cerebral aneurysms:a study of microsurgical anatomy

目的 探讨一侧入路显露两侧动脉瘤的可行性 ,并提供相应的解剖学基础。 方法 通过 2 0例国人成年尸头标本翼点开颅 ,显露对侧前循环五个动脉瘤好发部位 :眼动脉 (OA)段、后交通动脉 (PCOA)、颈内动脉 (ICA)终末段、前交通动脉 (ACOA)段和大脑中动脉 (MCA)膝部分叉外 ,并进行显微解剖测量。 结果 成功显露率 :OA起始部为 65 %,PCOA起始部为 5 0 %,ICA终末分叉为 10 0 %,A COA起始部为 10 0 %,MCA膝部分叉为 60 %, 结论 严格选择双侧多发动脉瘤的病例 ,经一侧入路显露并夹闭所有动脉瘤是可行、安全和有效的。

Objective In order to investigate the feasibility of surgical clipping of all bilateral supratentorial aneurysms via a unilateral approach. Methods Fontotemporal Craniotomies were performed on 20 cadavers to study the contralateral exposure for five common aneurysm sites in the anterior circulation such as the ophthalmic artery (OA) segment,the posterior communicating artery (PCOA) segment,theinternal carotid artery (ICA) terminal segment,the anterior communicating artery (ACOA) segment,as well as the middle cerebral artery (MCA) bifurcation. Results The contralateral OA segment was successfully exposed in 65% of specimens,the PCOA segment in 50%,the ICA terminai segment in 100%,the ACOA segment in 100% and the MCA bifurcation in 65%. Conclusion In this study,we select seriously surgical signs,it is very feasible and effective for neurosurgeon to clip successively all aneurysms of bilateral supratentorial via a approach.