显微手术治疗前循环动脉瘤

Microsurgical Management of Anterior Circulation Aneurysms

目的:探讨颅内前循环动脉瘤的手术时机和技术。方法:本组74例颅内前循环动脉瘤患者(其中急性出血66例)共82枚动脉瘤。使用Hunt&Hess分级法进行术前临床评价,采用翼点、半球间和眶上锁孔入路进行动脉瘤夹闭。早期(急性出血3 d内)夹闭动脉瘤41例,其他行延迟手术。结果:良好60例,轻残2例,重残2例,死亡10例。结论:除术前Ⅳ和Ⅴ级病例主张延期手术外,颅内动脉瘤破裂后应积极争取早期手术夹闭。正确的手术方案和熟练的显微操作技术是颅内动脉瘤手术成功的关键。

Aim： To study the timing and techniques of operation on intracranial anterior circulation aneurysms. Methods： 74 patients （66 patients with acute subarachnoid hemorrhage ） with 82 anterior circulation aneurysms have been treated by microsurgery. Hunt ＆ Hess grading system is used to evaluate the preoperative clinical condition. These aneurysms are performed by clipping through pterional,interhemispheric and supraorbital key hole approaches. 41 cases have been treated by early microsurgical clipping （within first 3 days after subarachnoid hemorrhage ）, the others by delayed operation （ performed 3 weeks after subarachnoid hemorrhage ）. Results： Good recovery is made in 60 patients, moderate disablity in 2 patients, severe disablity in other 2 patients and death in 10 patients. Conclusions： Except those patients with grade Ⅳ and Ⅴ, all patients should be treated by early microsurgical clipping. Excellent preoperative plan and experienced microsurgical technique are the key to get good results.