后交通动脉瘤的显微手术治疗

Microsurgical treatment for posterior communicating artery aneurysms

目的总结显微手术治疗后交通动脉瘤的经验。方法回顾性分析108例后交通动脉瘤病人的临床资料,采用翼点入路显微手术治疗,行瘤颈夹闭术107例,动脉瘤包裹术1例。瘤颈夹闭后术中常规切开瘤体并行吲哚菁绿荧光血管造影。结果动脉瘤颈完全夹闭107例,动脉瘤包裹1例。术中动脉瘤破裂18例。术前脑积水11例,术后改善6例,无明显改善5例。术后GOS评分:4～5分93例,2～3分11例,1分(死亡)4例。84例获随访6～12个月,无动脉瘤残留及复发。结论显微手术是治疗后交通动脉瘤的理想方法,术中常规切开瘤体并行吲哚菁绿荧光血管造影可有效判断夹闭效果。

Objective To review experience with microsurgical treatment for posterior communicating artery （PCoA） aneurysms. Methods Clinical data of 108 patients with PCoA aneurysms treated by microsurgery through the pterional approach were analyzed retrospectively, including clipping of aneurysmal neck in 107 cases and wrapping of aneurysm in 1. Aneurismal incision and the indocyanine green angiography were routinely performed after the clipping. Results Total clipping of aneurysmal neck in 107 cases and wrapping of aneurysm in 1. Intraoperatively intracranial aneurysm burst ruptured in 18 patients. Preoperative hydrocephalus occurred in 11 cases, and improved in 6 and no significantly improved in 5 postoperatively. The postoperative GOS scores were as follows： 4 to 5 scores in 93 patients, 2 to 3 in 11 and 1 （death） in 4. Eighty-four patients were followed up for 6 to 12 months, and there was no residual aneurysm or recurrence. Conclusions Microsurgery is an ideal method for treatment of PCoA aneurysms. Intraoperatively aneurysmal incision and the indocyanine green angiography are useful in judging the clipping effect.