翼点入路显微外科治疗前循环动脉瘤

Microsurgical treatment for the anterior circulation aneurysms

目的探讨前循环动脉瘤患者手术时机的选择,总结经翼点入路显微手术治疗前循环动脉瘤的手术经验。方法回顾性分析2007-2008年间57例经翼点入路手术夹闭前循环动脉瘤患者的临床资料。Hunt-Hess分级:0级1例,Ⅰ级8例,Ⅱ级25例,Ⅲ级19例,Ⅳ级4例。结果完全夹闭56例,不完全夹闭3例,包裹2例。以GOS分级为预后标准,恢复良好47例、轻残5例、重残2例、死亡3例。结论在前循环动脉瘤的显微手术中,根据患者具体情况,选择早期手术,术者掌握熟练的显微手术技巧;操作轻柔,尽量减少脑牵拉,充分解剖颅底脑池和尽量暴露载瘤动脉近端,可以提高手术成功率,有效地降低前循环动脉瘤患者的致残率和致死率。

Objective To summarize the experience of microsurgical treatment for the anterior circulation aneurysms, and to explore the optimal moment of surgical management for the anterior circulation aneurysms. Methods The clinical data of 57 patients with an- terior circulation aneurysms were retrospectively analyzed. According to Hunt-Hess grade, there was 1 case of grade 0,8 cases of grade Ⅰ ,25 cases of grade Ⅱ , 19 cases of grade Ⅲ, and 4 cases of grade IV. Results According to GOS classification criteria for the prog- nosis ,47 of 57 cases cured ,5 cases had slight disability ,2 cases showed severe disability ,and 3 cases died. Conclusion In the mi- crosurgery for anterior circulation aneurysms, the patients should be early operated according to the clinical signs, and some surgical techniques should be adopted and improved,which can effectively reduce the disability and mortality of patients with aneurysms.