经纵裂间入路治疗破裂前交通动脉瘤

Surgery on ruptured anterior communicating artery aneurysm via interhemispheric approach

目的探讨经纵裂间入路治疗破裂前交通动脉瘤的临床疗效。方法中国医科大学附属第一医院神经外科神经血管病病房自2008年1月至2009年8月采用经纵裂间入路治疗破裂前交通动脉瘤患者23例，回顾性分析患者的临床资料及手术效果。结果动脉瘤均成功夹闭，其中3例动脉瘤术中破裂出血，8例夹闭动脉瘤颈后切除动脉瘤。所有患者术后1d及出院时头部CT证实无脑积水和脑组织缺血梗死发生。术后第3天行经颅多普勒超声检查提示有5例患者出现脑血管痉挛，其中2例患者出现额叶精神症状，1周后恢复。本组无手术致残及死亡者。结论经纵裂间入路可以充分显露前交通复合体、动脉瘤颈并夹闭前交通动脉瘤，同时可以清除血肿．减轻术后血管痉挛，临床效果令人满意。

Objective To explore the efficacy of surgery on ruptured anterior communicating artery aneurysm via interhemispheric approach Methods An analysis and summary of the clinical data were performed in 23 patients with anterior communicating artery aneurysm, admitted to our hospital from January 2008 to August 2009. The clinical manifestations and surgical outcomes were analyzed to evaluate the significance of interhemispheric approach. Results Three aneurysms ruptured during the operation, and 8 aneurysms were excised after being clipped. All patients received CT scan 1 d after the operation and on the day the patients discharged to confirm that no hydrocephalus and brain tissue infarction appeared. All the patients were performed transcranial Doppler ultrasonography on the 3a d of operation, indicating that 5 patients emerged cerebral angiospasm, and 2 of these 5 patients appeared frontal psychiatric symptoms and recovered 1 week later. No disability or death was noticed. Conclusion Interhemispheric approach enjoys its superiority in treating anterior communicating artery aneurysm： it can help to expose the anterior communicating artery complex and neck of the aneurysm, therefore, anterior communicating artery aneurysm can be clipped, and the interhemispheric hematoma can be cleaned up and the happening of post-operative vasospasm can be decreased.