锁孔手术治疗老年人颅内动脉瘤

Keyhole approach in surgical treatment for elderly patients with intracranial aneurysm

目的探讨老年人颅内动脉瘤的临床特征及锁孔手术治疗效果。方法回顾性分析本院2000～2004年经锁孔手术夹闭的48例老年颅内动脉瘤患者的病例资料，其中眶上锁孔入路27例，翼点锁孔入路20例，半球间锁孔入路1例。结果治疗前Hunt-Hess Ⅰ～Ⅲ级37例，出院时完全恢复19例，轻残11例，重残3例，死亡4例；Hunt-Hess Ⅳ～Ⅴ级11例，出院时完全恢复1例，轻残2例，重残4例，死亡4例。对36例患者进行了随访，随访时间6月～3年（平均11月），10例症状与体征有明显的改善，余无明显变化。结论高血压是老年人颅内动脉瘤形成和破裂的重要影响因素；对Hunt-Hess分级Ⅰ～Ⅲ级者应争取早期手术治疗；锁孔手术可作为老年人颅内动脉瘤首选治疗方案之一。

Objective To investigate the clinical feature of elderly patients with intracranial aneurysm and to study the efficiency of the keyhole approach in the treatment for intracranial ancurysm. Methods Forty-eight elderly cases of intracranial ancurysm treated with keyhole approach in this hospital between 2000 and 2004 were analyzed retrospectively. Eyebrow keyhole approach was performed in 27 eases, pterional keyhole approach in 20 cases and inter-hemisphere keyhole approach in one case. The outcomes of the patients were assessed by the GOS upon discharge. Results Of the 48 patients, there were 37 cases of Hunt-Hess grade Ⅰ to Ⅲ ,in which 19 cases had a good outcome, 11 cases had a mild disability, 3 cases had a severe disability and 4 cases died; 11 cases of Hunt-Hess grade Ⅳ to Ⅴ had a worse outcome, including four cases of deaths. Conclusions Hypertension is regarded as one of the important factors for formation and rupture of elderly intracranial aneurysm. Elderly patients with Hunt-Hess grade Ⅰ to Ⅲ should undergo operation as early as possible. Keyhole surgery may be one of the suitable ways to treat the elderly patients with intraeranial aneurysm.