大脑中动脉动脉瘤的显微手术治疗（附72例报告）

Microsurgical management of middle cerebral artery aneurysms （72 cases reports）

目的 探讨大脑中动脉动脉瘤（MCAA）的临床特点和显微手术治疗的疗效.方法 回顾性分析72例显微手术治疗的MCAA患者的临床资料.72例共发现MCAA 75个,位于M1段10个,M2分叉处61个,远端4个.以蛛网膜下腔出血为主要表现66例,伴有血肿23例.入院时Hunt-Hess分级：0级6例,Ⅰ级6例,Ⅱ级28例,Ⅲ级18例,Ⅳ级9例,V级5例.所有患者均经翼点入路显微镜下行动脉瘤夹闭或包裹术,术中用微血管多普勒监测血流情况.结果 手术成功夹闭动脉瘤68例,夹闭加包裹4例.随访3-24个月,恢复良好62例（86%）,重残4例（6%）,植物状态2例（3%）,死亡4例（5%）.无复发或再出血的患者.结论 术前评估和手术入路是治疗MCAA的关键.术中应尽量避免对穿支血管的损伤,防止术后发生脑梗死.

Objective To investigate the clinical features of middle cerebral artery aneurysms （MCAAs） and effects of microsurgical management. Method Seventy two patients with 75 MCAAs underwent microsurgical treatment between January 2007 and January 2009 were analyzed retropectively. There were 10aneurysms in M1 segment, 61 MCA bifurcation and 4 distal portion. Sixty-six patients presented with subarachnoid hemorrhage（SAH）, of which 23 cases were associated with intracerebral hematoma. According to Hunt-Hess classification, 6 cases were grade 0, 6 gradeI, 28 grade Ⅱ, 18 grade Ⅲ, 9 grade Ⅳ and 5 grade V. All patients were underwent aneurysm clipping or wrapping microsurgically through pterional approach.Microvascular Doppler was applied intraoperatively to detect the blood flow of MCA and related branches.Results A total of 68 cases were operated successfully by surgical clipping, 4 cases by clipping plus wrapping. Fifty-two patiens（72%） had good recovery and 4 died （6%）. Follow up ranged from 3 to 24months, good recovery was achieved in 62 cases（86%）, severe disability in 4 （6%） and vegetative state in 2 （3%）. There was no recurrence or rebleeding. Conclusions Sufficient preoperative evaluation and suitable operative approach are the key for successful management of MCAAs. Damage of MCA branches should be avoided to decrease the occurrence of post-operative cerebral infarction.