129例颅内大型和巨大型动脉瘤的显微手术治疗

Microsurgical treatment of large and giant intracranial aneurysms:experience of 129 patients

目的探讨颅内大型和巨大型动脉瘤的临床特点以及术中处理技巧,提高手术疗效。方法总结分析我院129例颅内大型及巨大型动脉瘤的手术经验。其中瘤颈部夹闭110例,夹闭+包裹9例,瘤体电凝后包裹3例,载瘤动脉夹闭2例,动脉瘤切除2例,巨大动脉瘤切除后同时行吻合2例,动脉瘤旷置+颅外-颅内高流量架桥术1例。手术采用近侧载瘤动脉暂时性阻断、动脉瘤内减压、动脉瘤重塑等技术,其中10例患者术中应用神经内镜辅助夹闭动脉瘤和Transonic HT313血流量仪检测载瘤动脉血流情况。结果术后根据改良Rankin评分,恢复良好116例(89.9%),功能障碍9例(7.0%),死亡4例(3.1%)。结论通过术前完善的影像学判断及详细的手术计划,熟悉动脉瘤区域的解剖关系,进行有效的脑保护,使用多手段处理动脉瘤的技术,可明显提高颅内大型和巨大型动脉瘤手术治疗效果;术中应用神经内镜辅助夹闭动脉瘤和血流量仪检测载瘤动脉血流技术有助于减少术后并发症的发生。

Objective To explore the clinical features and operative techniques of large and giant intracranial aneurysms and to improve its therapeutic effects.Methods Surgical experiences of 129 patients with large and giant aneurysms were analyzed retrospectively.Clipping of aneurysms was achieved in 110 cases,clipping and coating in 9 cases,wrapping with electric coagulation in 3 cases,clipping of the parent artery in 2 cases,resection of aneurysms in 2 cases,resection of giant aneurysms in combination with anastomosis in 2 cases and exclusion of aneurysm with bypass in 1 case.Temporary proximate occlusion of parent artery,reduction of intra-aneurysmal pressure,remodeling technique were used in the operation,and endoscope-assisted microsurgery and Transonic HT313 Flowmeter were also used in 10 cases of aneurysms to detect the blood flow of the parent artery.Results According to Modified Rankin Score（mRS）,good outcome achieved in 116 cases（89.9%）,poor in 9 cases（7.0%）,and death in 4 cases（3.1%）.Conclusion Preoperative imaging,detailed operation scheme,being familiar with the anatomical structure of aneurysm area,effective cerebral protection,and a variety of techniques in the management of aneurysms may improve the therapeutic effect of large and giant aneurysms.The use of endoscope-assisted microsurgery and flowmeter is helpful to reduce the occurance of complications.