眶上外侧入路在颅内前循环动脉瘤破裂急性期显微手术中的应用

Lateral supraorbital approach applied to microsurgery of anterior circulation aneurysms at acute phase

目的探讨颅内前循环动脉瘤破裂急性期显微手术眶上外侧入路的临床应用，并与常规翼点入路相比较。方法回顾性分析2011年6月至2011年12月苏州大学附属第一医院经治的颅内前循环动脉瘤破裂急性期显微手术74例患者临床资料，分为2组：经眶上外侧入路手术组38例，经翼点入路手术组36例，总结相关临床资料，进行统计学分析。结果眶上外侧人路手术组38例患者手术切口长度平均（9．2±1．5）cm，术中动脉瘤破裂5例，均成功夹闭破裂及未破裂动脉瘤，手术时间平均（142±32）min，住院时间平均（11．9±4．3）d，出院2个月GCS评分，恢复良好33例（86．8％），轻度残疾5例（13．2％），无重度残疾病例，无植物生存病例，出院2月后未发现颞肌萎缩的病例。和翼点人路病例组比较，术中动脉瘤夹闭成功率及术后恢复良好率差异无统计学意义（P〉0．05）。手术时间、手术切口长度及住院天数差异有统计学意义（P〈0．05）。结论在颅内前循环动脉瘤破裂急性期的治疗方法中，眶上外侧人路是一种安全、微创的手术人路，技术难度要求相对较小．更适合广泛开展。

Objective To analyze the clinical practice ofmicrosurgical operation in intracranial ruptured aneurysms of anterior circulation via lateral supraorbital approach and pterional approach. Methods A retrospective analysis was performed on the clinical data of 74 patients with intracranial ruptured aneurysms of anterior circulation, admitted to our hospital from June 2011 to December 2011; 38 patients were assigned to neurosurgical treatment via lateral supraorbital approach, while the other 36 were performed neurosurgical treatment v/a pterional approach. Statistical analysis was performed on the clinical data. Results In the patients performed neurosurgical treatment via lateral supraorbital approach, the average operation time was （142±32） min, average length of incision was （9.2±1.5） cm, and the mean hospital stay was （11.9±4.3） d. Two months after discharge, 33 got recovery and 5 had light disability; no severe disability or PVS was observed. No significant difference was noted in good recovery rate and clipping success rate between the two group patients （P〉0.05）, but significant differences were observed in the operation time, length of incisions, and mean hospital stay between the two group patients （P〈0.05）. Conclusion Neurosurgical treatment via lateral supraorbital approach is a safe and mini-invasive method for intracranial ruptured aneurysms of anterior circulation, which is more suitable for extensive promotion.