前循环动脉瘤显微外科手术治疗

Microsurgical treatment for anterior circulation aneurysms

目的探讨前循环动脉瘤患者的手术时机,总结临床经验。方法回顾分析210例前循环动脉瘤患者显微外科手术资料,其中183例伴蛛网膜下隙出血患者HuntHess分级为Ⅰ～Ⅱ级82例、Ⅲ级77例、Ⅳ级21例和Ⅴ级3例。结果共199例行动脉瘤瘤颈夹闭术,11例行动脉瘤切除包裹术。Glasgow预后分级恢复良好者97例(46.19%)、轻残80例(38.09%)、重残24例(11.43%)、死亡9例(4.29%)。结论前循环动脉瘤的显微外科手术需根据患者具体情况选择手术时机,对不同类型前循环动脉瘤术中的判断及处理措施,是手术获得成功的重要因素。

Objective To explore the optimal moment of surgical management for the anterior circulation aneurysms, and to summarize the experience of microsurgical treatment for the anterior circulation aneurysms. Methods The clinical data of 210 patients with anterior circulation aneurysms were retrospectively analyzed. In 183 patients with subarachnoid hemorrhage, there were 82 cases of grade Ⅰ-Ⅱ, 77 cases of grade Ⅲ, 21 cases of grade Ⅳ, 3 cases of grade Ⅴ according to Hunt Hess grade. Results 199 patients underwent aneurysm clipping and 11 patients were underwent aneurysm wrapping. According to Glasgow Outcome Scale （GOS） classification criteria for the prognosis, 97 cases （46.19% ） cured, 80 cases （38.09% ） had slight disability, 24 cases （11.43% ） showed severe disability, and 9 cases （4.29% ） died. Conclusion In the microsurgery for anterior circulation aneurysms, the patients should be early operated according to the individual clinical signs. The judgment and skills in surgery for the subtypes of anterior circulation aneurysms are the key points to cure intracranial aneurysms successfully.