大脑前动脉远端破裂动脉瘤的显微外科治疗

Microsurgical treatment for ruptured distal anterior cerebral artery aneurysms

目的探讨破裂大脑前动脉远端动脉瘤的临床特征和显微外科治疗方法。方法回顾性分析2006年8月～2011年7月经手术夹闭的10例患者的临床资料。术前Hunt-Hess分级I级2例,II级2例,III级5例,IV级1例。64排CT血管造影(CTA)或脑血管造影(DSA)确诊。瘤体直径在3～16 mm之间,位于A2段3个,采用翼点入路;A3段7个,采用经大脑纵裂间入路。结果 10例患者的动脉瘤均经显微手术成功夹闭。2例为多发动脉瘤,其中1例大脑中动脉分叉处动脉瘤一期予以夹闭,另1例基底动脉梭形动脉瘤未予治疗。9例患者治疗效果满意,无明显神经功能缺损和其他并发症,1例术后并发严重脑血管痉挛死亡。按照GOS预后评分,9例恢复良好,1例死亡。结论采用合适的手术入路和具备良好的显微手术操作技巧夹闭DACAA,可获得满意的临床效果。

Objective To evaluate the clinical features and microsurgical strategies of ruptured distal anterior cerebral artery aneurysms （DACAA）. Methods 10 consecutive cases of ruptured DACAA operated from August 2006 to July 2011 were reviewed and followed up. According to Hunt- Hess classification, 2 belonged to grade I, 2 grade II, 5 grade III and 1 grade IV. All patients were made definite diagnosis by 64 rows helical CT angiography （CTA） or Digital Subtraction Angiography （DSA）. The diameter of all DACAAs was between 3-16 ram. Pterional approach was selected for 3 cases with A2 aneurysm, 7 cases with A3 aneurysm underwent interhemispheric approach. Results 10 ruptured DACAAs were clipped through microsurgery in 10 cases. 2 cases carried multiple aneurysms. One middle cerebral artery bifurcation aneurysm was clipped through one-stage operation, the other fusiform basal artery aneurysm didn/t receive surgical treatment. According to Glasgow Outcome Scale, all cases were favorable except one death due to severe postoperative cerebral vasospasm. Conclusion Successful clinical management of DACAA depends on appropriate surgical approach and skilled mierosurgery techniques.