颅内前循环动脉瘤的锁孔手术治疗

Microsurgical treatment of intracranial anterior circulation aneurysm via keyhole approach

目的探讨锁孔入路治疗颅内动脉瘤的手术技术和治疗效果。方法采用锁孔入路对85例术前Hunt-Hess分级Ⅰ～Ⅱ级的颅内前循环动脉瘤实施手术治疗，其中75例行经翼点锁孔手术入路．10例经眉弓锁孔入路手术，骨瓣大小4cm×3cm。结果85例动脉瘤显微镜下手术成功夹闭。翼点入路术中动脉瘤破裂1例，眉弓入路术中动脉瘤破裂1例，1例出现手术后急性硬膜下血肿。患者术后1～3月复诊，恢复良好82例（96％），轻残3例（4％）。结论锁孔入路显微手术夹闭动脉瘤创伤小．并发症少，手术效果满意。

Objective To explore the operative techniques and evaluate the effect of treating intracranial aneurysms via keyhole approach. Methods Aneurysm clipping through the keyhole approach was performed in 85 patients with anterior circulation aneurysms, who were in grade Ⅰ to Ⅱ according to Hunt-Hess scale. Among them 75 cases were clipped through the pterion keyhole approach with a bone flap size 4 cm×3 cm and 10 cases through the superciliary arch keyhole with a bone flap size 3 cm ×（2.5-3） cm. Results The intracranial anterior circulatory aneurysms in 85 cases were successfully clipped under microscope. Among them, 1 case operated through pterion keyhole approach experienced accidental rupture intraoperatively; 1 case operated through superciliary arch keyhole had an accidental rupture intraoperatively and another 1 case suffered from acute subdural hematoma postoperatively. During the revisiting within 1-3 months, the patients were evaluated according to GOS （Glasgow Outcome Scale）. Good recovery was achieved in 82 cases （96%）, mild or moderate disability in 3 cases （4%）. Conclusion Microsurgery via keyhole approach can reduce iatrogenic trauma and complications and helps to obtain the best treatment effect.