经翼点入路显微手术治疗颅内动脉瘤54例

54 cases of intracranial aneurysms under microsurgical treatment via pterional approach

目的 探讨经翼点入路显微手术治疗颅内动脉瘤的方法。 方法 应用显微神经外科技术,对54例颅内动脉瘤患者进行直视手术。经翼点人路,以Mayfied三头钉头架固定头部,取自耳屏前方、颧弓上缘至中线发际内作弧形切口。根据需要充分显露载瘤动脉后,再解剖瘤颈。结果 54例颅内动脉瘤手术夹闭成功,以格拉斯哥术后评分量表对患者神经功能评分,评分为好的患者48例,差者3例,死亡3例。 结论 经翼点入路,应用显微外科技术,手术路径最短,视野角度最大,是手术治疗大脑动脉环动脉瘤的经典入路。

Objective To summarize the microsurgical technique of pterional approach in treating for intracranial aneurysrns. Methods 54 patients of intracranial aneurysms were reviewed retrospectively. The technique of pterional approach for the microsurgical treatment was summarized in several aspects: (1) the selection of the operation time; (2) the management of aneurysm rupture during the operation; (3) the prevention and treatment of blood vessel spasm in post-operative period. Glasgow outcome scale(GOS) was used to evaluate the postoperative neurofunction of patients. Results All aneurysms were clipped successfully. Good outcomes (GOS scores is 4 or 5) were achieved in 48 patients, poor outcomes (GOS scores is 2 or 3) in 3 patients, and death in 3 patient. Conclusion Good outcome can be achieved in patients with aneurysms who accepted microneurosurgery via pterional approach at early stage.