锁孔入路显微手术治疗颅内前循环动脉瘤

Microsurgery through pterional and supraorbital keyhole approaches for the anterior circulation aneurysms

目的探讨前循环动脉瘤经翼点锁孔入路和经眉弓眶上锁孔入路的手术方法及疗效。方法 16例前循环动脉瘤患者中,前交通动脉瘤8例,采用经眉弓眶上锁孔入路手术治疗;后交通动脉瘤6例,大脑中动脉分叉及颈内动脉分叉动脉瘤各1例患者则均采用经翼点锁孔入路手术治疗。手术在发病后1~3d进行,均以直径2cm×（3～4）cm的微骨窗行显微外科手术夹闭。结果 16例动脉瘤全部一次手术夹闭成功,其中2例术中发生动脉瘤破裂出血,无手术死亡及其他严重并发症,随访16例全部恢复良好。结论锁孔入路治疗前循环动脉瘤安全、微创、有效;完善的个体化术前设计、精湛的手术技巧及良好的术中配合是手术成功的重要保证。

Objective To explore the operative techniques of microsurgery through pterional and supraorbital keyhole approaches and its curative the effect on the intracranial anterior circulation aneurysms.Methods Sixteen patients with anterior circulations aneurysms,of whom,8 suffered from anterior communicating artery aneurysms,6 posterior communicating artery aneurysms,1 middle cerebral artery aneurysms,and 1 internal carotid artery bifurcation aneurysms,were treated by microsurgery through supraorbital or pterional keyhole approaches from 1 to 3 days after the rupture of the aneurysms.Results The intracranial anterior circulatory aneurysmsin 16 patients were successfully clipped.The rupture of the aneurysms occurred during the operation in 2 patients.No patients died of the operation.There were not severe operative complications in all the patients.The following-up from 1 to 8 months showed that all the patients were recovered well.Conclusions The intracranial anterior circulation aneurysms can be safely treated,effectively by microsurgery through supraorbital or pterional keyhole approach.The prefect preoperation preparation,individualized surgical plan,excellent surgical technique and good cooperation during the operation are the key to the successful microsurgery through pterional and supraorbital keyhole approaches for the anterior circulation aneurysms.