应用额眶-翼点入路急诊处理破裂性前交通动脉瘤

Application of fronto-orbital-pterional approach for emergency treatment of ruptured anterior communicating artery aneurysm

目的探讨应用改良额眶翼点入路处理前交通动脉瘤破裂导致颅内血肿的诊断和急诊手术治疗的经验。方法回顾性分析前交通动脉瘤破裂合并颅内血肿病人14例临床资料,术前均行CTA检查,采用该入路开颅,充分显露动脉瘤然后夹闭,并行血肿清除。结果本组无1例死亡,该入路可缩短手术操作距离,对深部结构的观察角度明显扩大,消除视路死角,牵拉性损伤明显减少。14例动脉瘤成功夹闭,清除血肿较完全。结论前交通动脉瘤导致颅内血肿,病情凶险,需尽早行CTA检查明确诊断,手术是首选,改良额眶翼点入路具有手术野暴露好,术中不需行复杂的骨切除,减少牵拉造成的脑血管痉挛及脑损伤。降低病残率,病死率。

Object To study the experience of diagnosis and emergency operation of anterior communicating artery with intracranial hematoma by improved pterion approach. Methods 14 cases suffering from anterior communicating artery with intracranial hematoma were studied retrospectively, All the patients were examined by CTA before operation, and operated by improved pterion approach. Clipped the aneurysm after exposed the surgical field adequately, and then removed the hematoma. Results The group no one died. This approach can shorten the surgical operation distance, expand the viewing angle of deep structure, reduce traction injury. Aneurysm was clipped successfully in 14 cases. It also can thoroughly remove the hematoma. Conclusion Operation is the first treatment choice of intracranial hematoma induced by anterior communicating artery aneurysm, modified pterion approach can expose the surgical field fully. Without craniectom in the operation, reduce the vasospasm and brain damage induced by traction . The rate of disability and death can decrease obviously.