神经内镜辅助早期手术夹闭前交通动脉瘤临床研究

Clinical research of early anterior communicating aneurysms occlusion assisted by endoscopy

目的探讨神经内镜辅助夹闭前交通动脉瘤的临床价值。方法回顾性分析确诊的前交通动脉瘤患者28例,29个动脉瘤。均在起病早期行全脑血管造影(DSA)后神经内镜辅助下显微手术夹闭动脉瘤,对存活者临床随访半年以上并复查DSA。结果本组术中神经内镜检查显示夹闭前3例发现了显微镜下未能发现的穿通支血管,夹闭后发现3例瘤颈夹闭不全,2例误夹穿通支血管,无手术死亡,重残1例(3.57%),轻残5例(17.85%),恢复良好22例(78.57%),随访半年以上未见再出血或复发。结论前交通动脉瘤手术夹闭中引入神经内镜能提高动脉瘤手术的夹闭率,预防漏夹和误夹,减轻对正常神经组织的损害,减少术后并发症的发生率,提高了手术安全性和可靠性。

Objective To explore the clinical value of anterior communicating aneurysms occlusion supported by endoscopy. Methods Retrospective analyze the clinical materials of 28 patients with definite anterior communicating aneurysms, all of which were tested by digital subtraction angiography （DSA） at the early time of onset and then carried out occlusion by micrurgy with the help of endouscopy. All survivals aftet operation were followed up for more then 6 months and rechecked with DSA. Results 3 cases with aneurysmal neck pero-occlusion and 2 cases with perforating branch vascular misocclusion were discovered by endouscopy after occlusion, but which could be found nothing under the microscope. As the same, perforating branch vascular in 3 cases could be found by endoscopy but not by microscope before occlusion. In this study 1 cases（3.57% ） had got severe handicap, 5 cases（ 17.85% ） incured mild handicap and 22 cases（78. 57% ） obtained good restoration. Nobody died after operation and no rehaemorrhagia or recidivation was found in these cases after following up for more than 6 months. Conclusions Endoscopy can raise the success rate of anterior communicating aneurysms occlusion and obviate leakage of occlusion or misocclusion,which also can lighten operative injury to the normal nerve tissue and reduce the rate of postoperative complications so as to improving the safety and reliability of operation.