前交通动脉瘤的微创外科手术治疗

Minimally invasive surgical treatment of anterior communicating aneurysms

目的探讨前交通动脉瘤的临床影响因素和处理原则。方法回顾性分析微创手术治疗52例前交通动脉瘤的临床、治疗、随访资料。所有患者中大脑前动脉A1段优势42例,其中左侧优势31例,右侧优势11例。微创手术入路以优势供血侧翼点入路为主。夹闭动脉瘤48例,瘤囊包裹术4例,术中应用血管临时阻断技术15例。结果术后随访4月～1.5年,优良37例,轻残12例,重残1例,死亡2例。结论大脑前动脉一侧A1优势与前交通动脉瘤有密切关系。翼点入路微创手术治疗前交通动脉瘤是行之有效的方法。Hunt-HessⅠ～Ⅲ级的前交通动脉瘤应早期手术。夹闭动脉瘤前充分分离、显露前交通动脉复合体是手术成功的关键,Heubner回返动脉、穿支动脉的保护尤其重要。

Objective To explore the related clinical factors and the management of anterior communicating aneurysms.Method 52 anterior communicating aneurysms cases were found in the series of 138 intracranial aneurysms patients.The clinical,image and follow-up data were retrospectively analyzed.The dominant A1 incidence was 80.7%（42/52）in all patients.Most of 52 patients underwent minimally invasive surgical treatment through pterional approach on the dominant side of blood supply for the aneurysms,48 were clipped,4 were wrapped.Temporary occlusion of the parental arteries was performed in 15 cases.Results After 1.5 year＇s follow-up,the recovery was excellent or good in 37 patients,mild disability in 12 cases,severe disability in 1 patients and death in 2 cases.Conclusion The anterior communicating aneurysm is related directly with the dominant blood flow of A1.Minimally invasive surgical of anterior communicating aneurysm via pterional approach is the best choice.The operation should be performed within 3 days in patients with grade Ⅰ～Ⅲ of Hunt and Hess.Adequade dissection and exposure of the entire complex body of anterior communicating artery are the key to a successful clipping of aneurysms neck.The preservation of the Heubner artery and the perforating arteries should be specially emphasized.