经额下锁孔入路夹闭大脑前循环动脉瘤

The application of subfrontal keyhole approach in surgical treatment for intracranial anterior circulation aneurysms

目的探索经额下锁孔入路夹闭大脑前循环动脉瘤的优缺点,并与经翼点入路夹闭大脑前循环动脉瘤的手术相比较。方法取眉上顺额纹切口约6cm,行2.0cm×3.0cm或2.0cm×4.0cm的小骨瓣,手术夹闭前循环动脉瘤。结果因多发性脑梗塞死亡1例(1/78例,占1.2%),随访69例(随访时间1～24个月),均生活自理。结论经额下锁孔(或小骨瓣)入路夹闭大脑前循环动脉瘤,手术切口小,损伤轻,节省手术时间,术后保持容貌完整,是较为理想的入路。

Objective To evaluate the clinical strategy and effect of subfrontal keyhole approach and pterional appoach in surgical treatment for intracranial anterior circulation aneurysms. Methods The skin incision, located at superciliary arch along with the dermatoglyph, is about 6cm length. Boring a hole at the temporal line and shaping a 2.0cm × 3.0cm or 2.0cm × 4.0cm bone window including orbital border with milling cut. The anterior communicating artery aneurysms were treated with surgical clipping . Results The clinical mortality rate is 1.2% （ 1/78 cases）. 1 case died in excessive brain infract and 69 cases survived well after following up from 1 - 24 months. Conclusions The subfrontal keyhole approach is suitable for treating intracranial anterior circulation aneurysms which has the merit of minimal invasion, shortening the operation time, small operation skin incision and maintaining good appearance.