前循环巨大动脉瘤的显微手术治疗

Microsurgical treatment of the anterior circulation giant aneurysm

目的改进颅内巨大动脉瘤的显微手术技术,以提高颅内巨大动脉瘤的治疗效果。方法回顾性分析10例前循环巨大颅内动脉瘤的临床资料和手术效果,其中3例为双侧多发动脉瘤。术中应用载瘤动脉近端临时阻断、颈部颈内动脉暂时夹闭、动脉瘤颈逐步缩窄、动脉瘤体穿刺抽吸减压、动脉瘤体切除等技术,动脉瘤夹闭后以可吸收再生氧化纤维素包裹动脉瘤,并用丝线将动脉瘤夹固定于颅底硬膜上并,术程中始终应用生理盐水加维生素C及罂粟碱冲洗。结果10例动脉瘤手术全部成功夹闭,其中3例多发动脉瘤均一期手术成功夹闭。出院时优良者8例,轻残者2例。结论颅内巨大动脉瘤通过术前详细的手术计划,术中改进的手术技术和预防术后血管痉挛药物的应用可以明显提高颅内动脉瘤的手术治疗效果,减少术后并发症。应用丝线固定动脉瘤夹在最大程度上避免了术后因动脉瘤夹的滑脱而导致患者颅内大出血死亡。

Objective The microneuresurgery operative techniques were modified to improve the outcome of patients with intracranial giant aneurysms. Methods A retrospective analysis was made in 10 patients with intracranial anterior circulation giant aneurysms operated on from May 2006 to November 2006. The improved operative techniques were applied including temporary proximate ecclusion of parent artery and internal carotid artery in the neck, stepwise coagulation stenesis of aneurysms neck, sucking and decompressing the body of aneurysms, and resection of aneurysms bodies. After obliteration of aneurysm the clip was fixed on the cranial base dura by using silk and the bodies of aneurysms were packed by surgicel. The field was lavaged all the time in operation using saline containing the Vitamin C and Papaverine. Results The neuresurgical operations succeed in obliteration of aneurysm including 3 cases of bilateral intracranial aneurysms. Outcome was considered as good in 8 cases, fair in 2 cases. Conclusion It is very helpful to make up a detailed preoperative study, modified operative techniques and antivasospasm drugs application during the operation as to improve the clinical outcome and reduce the postoperative complication of vasospasm. It is important to fix the aneurysm clip on the cranial base dura in order to avoid the postoperative accidental death due to cerebral hemorrhage incurred by slippage of aneurysms clip.