翼点入路显微手术治疗前交通动脉瘤(附49例报道)

Microsurgical treatment via pterional approach of anterior communicating aneurysms(49 cases report)

目的探讨经翼点入路显微手术治疗前交通动脉瘤的手术时机、手术操作要点及疗效。方法回顾分析近3年49例前交通动脉瘤患者临床资料,均行翼点入路显微夹闭术,13例术中采用了血管临时阻断技术,2例术中行侧脑室穿刺,4例术中行终板造瘘。结果术后随访6～36个月,手术效果按GOS评分:恢复良好(5分)44例(89.8%),中度病残生活能自理(4分)2例(4.1%),重度病残生活不能自理(3分)1例(2.0%),死亡2例(4.1%)。结论翼点入路显微手术治疗前交通动脉瘤,术野显露清晰,对脑组织骚扰小,瘤颈夹闭可靠,疗效满意;尽早手术能降低动脉瘤再出血的风险及术后脑血管痉挛和脑积水发生几率;血管临时阻断技术的应用对于术中动脉瘤破裂、宽颈、巨大或粘连紧密的前交通动脉瘤具有重要作用。

Objective To explore the surgical timing,methods and efficacy of microsurgical treatment of anterior communicating aneurysms by pterional approach.Methods Clinical materials of 49 patients with anterior communicating artery aneurysm underwent microsurgery via pterional approach were analyzed retrospectively.Temporary occlusion of the parental arteries was performed in 13 cases.Results According to Glasgow Outcome Score,the curative effects were good in 85 cases（89.8%）,moderately disabled in l3 cases（4.1%）,severely disabled in 1 case（2.0%） and death in 2 cases（4.1%）.Conclusion Microsurgical operation of anterior communicating aneurysms via pterional approach is an effective method with good exposure and reliable neck clipping.The early surgery can avoid re-bleeding and reduce the morbidity of cerebral vasospasm and hydrocephalus.Temporary vascular occlusion plays an important role in intraoperative rupture and the anterior communicating aneurysms with wide neck,giant volume or close adhesion.