经翼点-纵裂入路显微外科治疗高位前交通动脉瘤

Microsurgical treatment via pterional interhemispheric approach for high-positioned anterior communicating artery aneurysms

目的探讨经翼点一纵裂入路夹闭高位前交通动脉瘤的显微外科手术技巧及处理方法。方法回顾性分析18例高位前交通动脉瘤的临床表现、影像学资料、手术方式及手术结果。结果出院时GOS评分5分12例，4分5例，3分1例。DSA复查均显示动脉瘤完全夹闭。CT复查发现颅内小梗死灶2例。随访3～36个月，无再出血及复发病例。结论经翼点一纵裂入路夹闭高位前交通动脉瘤的关键在于解剖纵裂池前控制双侧大脑前动脉A1段，快速打开纵裂池及注意双侧A1段的阻断时间。此外，合理选择动脉瘤夹、术中微血管多谱勒监测及血管穿通支的保护也很重要。

Objectives To explore the microsurgical technique and treatment methods for the high-positioned anterior communicating artery （ACoA） aneurysms via pterional interhemispheric approach. Methods Clinical and neuroimaging data, microsurgical procedures and outcomes of 18 patients with high positioned ACoA aneurysms were analyzed retrospectively. Results The GOS scores at discharge fiom hospital were as follows： 5 scores in 12 patients, 4 in 5 and 3 in 1 patient. The aneurysm neck was successfully clipped in 18 patients according to DSA reexamination, and lacunar infarction seen in 2 by CT reexamination. No rebleeding or recurrence occurred during a follow-up period of 3 to 36 months. Conclusions The technical key points of the surgical procedure via pterional interhemispheric approach for high positioned ACoA aneurysms are as follows： to control A 1 segment of the bilateral anterior cerebral artery before detaching interhemispheric cistern, quickly open the interhemispheric cistern and pay attention to blocking-up time. Additionally, it is also important to select the aneurysm clip, perform intraoperative microvascular Doppler monitoring and protect the perforating arteries.