锁孔显微手术治疗颅内动脉瘤

Microsurgical treatment for intracranial aneurysms by keyhole approach

目的探讨锁孔显微手术治疗颅内动脉瘤的可行性和临床疗效。方法回顾性分析391例共415个的动脉瘤病人的临床资料,均采用锁孔显微手术治疗。经眉弓锁孔入路127例,经翼点锁孔入路257例,经颞下锁孔入路2例,经纵裂锁孔入路5例。术中予以神经电生理监测103例,予以神经内镜辅助15例。结果术后随访2周～84个月,动脉瘤成功夹闭399个(96.1%),单纯包裹8个,孤立5个,孤立加切除3个。根据GOS评估标准,恢复良好366例(93.6%),12例(3.1%)有不同程度的残疾,死亡13例(3.3%)。结论锁孔显微手术是治疗颅内动脉瘤的理想方法,术中辅以神经电生理监测和神经内镜可增加手术成功率和安全性。

Objective To explore the feasibility and effect of microsurgical treatment for intracranial aneurysms by keyhole approach.Methods The clinical data of 391 patients with 415 aneurysms were analyzed retrospectively.All the patients underwent keyhole microsurgical treatments including supraorbital keyhole approach in 127 patients,pterional keyhole approach in 257,subtemporal keyhole approach in 2,longitudinal fissure keyhole in 5.Neurophysiological monitoring was performed in 103 patients and assisted by neuroendoscopy in 15.Results The follow-up period ranged from 2 weeks to 84 months：including 399（96.1%） successfully clipped aneurysms,8 ones wrapped alone,5 ones trapped,3 ones trapped plus resected.Glasgow Outcome Scale（GOS） score revealed 366（93.6%） patients recovered well,12（3.1%） had disability to varying degrees and 13（3.3%） died.Conclusions Microsurgical treatment via the keyhole is an ideal method for intracranial aneurysms.Intraoperative neurophysiological monitoring and neuroendoscopy can increase success rate and safety of operation.