显微手术治疗颅内前循环动脉瘤疗效及并发症分析

Microsurgical treatment of anterior circulation aneurysms via pterional approach： an efficacyand complication analysis

目的验证经翼点人路显微手术治疗颅内前循环动脉瘤的效果，探讨该术式的手术并发症。方法南京医科大学附属常州第二人民医院阳湖院区神经外科自2002年1月至2012年1月经翼点入路显微手术治疗颅内前循环动脉瘤患者61例，分析总结患者的疗效和并发症。结果本组患者中60个动脉瘤行夹闭术，3个行动脉瘤包裹术。61例患者中50例（81．97％）恢复良好；5例术后出现对侧偏瘫；4例出现癫痫；1例植物性生存；1例死亡。38例术后行DSA检查，14例行CTA检查，显示动脉瘤均消失，载瘤动脉恢复畅通；术后l～12月进行复查，7例出现精神障碍，8例术侧出现颞肌萎缩，3例患者出现脑积水，行脑室一腹腔分流术后痊愈；7例形成下肢静脉血栓，行积极抗凝治疗后痊愈；5例出现动脉眼神经麻痹症状，6～12个月后均恢复良好；2例因损伤眶上神经出现眼睑下垂；此外1例患者出现颅内感染，1例出现脑梗死。结论显微直视下切除或夹闭动脉瘤是治疗颅内前循环动脉瘤的一项有效方法．早期进行动脉瘤夹闭术可以减少并发症的发生。

Objective T.o explore the efficacy and complications of microsurgical treatment ofanterior circulation aneurysms via pterional approach. Methods The clinical data of 61 patients with intracranial aneurysms, diagnosed in our hospital from January 2002 to January 2012, were collected; their outcomes and complications were analyzed. Results Clipping was performed in 60 arterial aneurysms and bundling in 3 aneurysms. Fifty patients （81.97%） got good recovery accompanied by 5 having postoperative contralateral hemiplegia, 4 epilepsy, 1 vegetative state and 1 death. The DSA of 38 aneurysms and CTA of 14 aneurysms after the surgery confirmed that the aneurysms disappeared and the parent arteries restored patency. The postsurgical review （1-12 months after the surgery） showed that 7 patients had mental disorders, 8 had temporalis muscle atrophy, and 3 had hydrocephalus and ventriculo-peritoneal shunt was performed. Seven patients formed deep vein thrombosis cured after anticoagulant therapy. Five patients had arterial nerve paralysis, being good recovery after 6-12 months. Two patients had ptosis. One had intracranial infection and 1 cerebral infarction. Conclusion Excision or clipping the intracranial anterior aneurysms under direct vision by microscopy technique is an effective way; early surgery can reduce the incidence of complications.