颅内动脉瘤的显微手术(附95例报告)

Microsurgery of intracranial aneurysms: reports of 95 cases

目的 介绍９５ 例颅内动脉瘤显微神经外科手术的经验， 探讨显微手术技巧及动脉瘤破裂的处理。方法 在气管插管全麻及控制性低血压下手术。多采用改进的Ｙａｓａｒｇｉｌ 入路， 在显微镜直视下操作， 解剖动脉瘤颈， 稳妥地夹闭瘤蒂， 必要时行瘤体切除或瘤颈加固。结果 本组９５ 例中８５ 例行动脉瘤颈夹闭术，８ 例因瘤体巨大故在瘤颈夹闭后行瘤体切除术， 治愈率为９５－８％ 。术中动脉瘤破裂１０ 例， 死亡４ 例， 死亡率为４－２％ 。结论 显微神经外科技术对提高颅内动脉瘤手术成功率具有重要作用， 动脉瘤术中破裂出血是手术失败和致死的重要原因。

Objective Experience of microneurosurgery for treatment of intracranial aneurysms. To discuss the technique of microsurgery and to deal with the rupture of aneurysm. Methods All operation were carried on with controlled low blood pressure. Modified Yasargil's approach were adopted for the most patients. All protocols of surgery and placing aneurysm clips were under microscope. Aneurysm bodys were excised if neccesary. Results 85 aneurysms of 95 cases were completely clipped by aneurysm clips. The aneurym body were excised after clipping in 8 cases. The total cure rate was 95 8 percent and the mortality was 4 2 percent. There were ten cases ruptured during operation. Conclusion Skillful microsurgery technique is most important role for improving the success rate of operation. The main causes of failure and death were the rupture of aneurysm during operation. The authors suggest that the emergency measures during operation are administrating the controlled hypotension anesthesia and blocking the parent artery with a suitable aneurysm clip