前交通动脉瘤34例显微外科手术治疗

Microsurgical treatment of 34 cases of anterior communicating artery aneurysm

目的探讨前交通动脉瘤的临床病理特点、手术时机及手术疗效。方法回顾性分析34例行显微外科手术治疗的前交通动脉瘤患者的临床资料。所有患者手术入路均采取翼点或改良翼点入路,然后对动脉瘤进行显微镜下夹闭手术。结果入组34例患者中,31例(36处)动脉瘤夹闭效果满意,其余3例(3处)动脉瘤夹闭不全,针对夹闭不全部位进行可脱性弹簧圈栓塞。GOS评分结果示,预后良好26例,预后不良8例(包括死亡2例)。结论翼点入路有利于前交通动脉动脉瘤夹闭手术的顺利进行,前交通动脉复合体的充分解剖及合适的动脉瘤夹是手术成功的关键;对于Hunt-Hess 0～Ⅲ级患者应于出血3d内进行手术,Ⅳ～Ⅴ级患者应于病情稳定后再进行手术。

Objective To investigate the clinical and pathological features,the surgery opportunity and the surgery efficacy of anterior communicating artery aneurysm.Methods The clinical data of 34 cases of anterior communicating artery aneurysm treated by microsurgery were analyzed retrospectively.All the patients received microsurgery through pterional approach.Results Of the 34 patients,36 aneurysm in 31 patients were clipped satisfactorily;3 aneurysm in 3 patients were clipped incompletely,and the spring coil was used.According to GOS scores,the good prognosis was observed in 26 patients,and the poor prognosis in 8 patients（including 2 patients of death）.Conclusion Pterional approach is in favor of the succession of anterior communicating artery aneurysm surgery,the full anatomy of anterior communicating artery complex and appropriate aneurysm clip are the keys to succession;the patients with grade Hunt-Hess 0~Ⅲ should receive the surgery within 3 days,the patients with grade Ⅳ~Ⅴ should receive the surgery after the patient＇s condition stabilized.