颅内前循环动脉瘤夹闭术的显微外科技术

Study on microsurgical techniques of clipping of intracranial anterior circular aneurysms

目的总结我院自2004年以来采用显微神经外科手术治疗的104例颅内前循环动脉瘤的经验,探讨颅内前循环动脉瘤夹闭术的显微手术技巧,以期进一步提高该病的临床治疗效果。方法104例颅内前循环动脉瘤病人中,1例胼周动脉瘤采用前纵裂入路,1例后交通合并胼周动脉瘤采用翼点和前纵裂的联合入路,其余部位的动脉瘤均采用改良翼点入路。手术采用显微外科技术解剖脑池,锐性分离瘤颈并夹闭之。术中采用控制性降压、载瘤动脉临时阻断和动脉瘤体翻转等技术以防止破裂出血和误夹正常血管。结果104例手术病人中,102例成功夹闭瘤颈,2例采用了动脉瘤包裹术。术后病人恢复良好78例,轻残17例,重残6例,植物生存2例,死亡1例。结论采用显微外科技术夹闭动脉瘤颈是治疗颅内前循环动脉瘤的根本方法;术中采用控制性降压、载瘤动脉临时阻断和动脉瘤体翻转等技术以防止破裂出血和误夹正常血管,可以提高颅内前循环动脉瘤的手术治疗效果。

Objective The clinical experience on the 104 patients with intracranial anterior circular aneurysm which were clipped by microsurgical techniques during the past 3 years were retrospectively summarized in order to explore the microsurgical techniques of clipping of intracranial anterior circular aneurysm and to improve the surgical outcome of the patients, Methods Modified transpterional craniotomy was performed for the patients with intracranial anterior circular aneurysm except the pericallosal aneurysms and some multiple intracranial aneurysms. After the dura was opened microsurgical techniques were used to dissect brain cisterns and the neck of aneurysm sharply and clip them safely. During the operation controlled hypotension and temporary blocking of patent artery was utilized to prevent severe bleeding caused by unexpectable rupture of the aneurysms. For the purpose of protecting of perforating artery and clipping the aneurysm safely the body of the aneurysm may be pulled out of the surrounding substructures in some special circumstance, Results Among the 104 cases with intracranial anterior circular aneurysm,102 aneurysms were successfully clipped and 2 aneurysms were wrapped. After operation,78 cases recovered,17 cases were mild disabled,6 cases were severely disabled,2 cases failed into persistent vegetative state and 1 case died. Conclusions Clipping of the neck of aneurysm by microsurgical techniques is the primary therapeutical choice for most of the intracranial anterior circular aneurysms and the effects are gratifying. By application of controlled hypotension and temporary blocking of patent artery,severe bleeding can be prevented effectively. On some special circumstances,the body of the aneurysm may be pulled out of the surrounding substructures with the aim of protecting of perforating artery and clipping the aneurysm safely.