突向内侧的床突旁动脉瘤的显微手术治疗

The Microsurgery of the Medial Paraclinoid Aneurysm

目的研究内侧型床突旁动脉瘤的特点并将之应用于显微手术治疗。方法回顾性分析2008年1月至2011年1月北京宣武医院收治的31例内侧型床突旁动脉瘤患者的临床资料,分析动脉瘤的解剖特点及与周围组织的关系,以便在最小的创面下对动脉瘤行理想的夹闭。结果 20例未磨除前床突的患者仅在打开部分视神经鞘的情况下动脉瘤得到很好的夹闭,其中仅有1例术后出现视力变差,1例患者术后3 d出现部分颞叶梗死;6例因暴露需要术中磨除前床突的患者中,术后有3例出现不同程度的动眼神经麻痹症状,1例术后出现视力变差,仅2例无明显的术后并发症;5例采用对侧翼点入路行动脉瘤夹闭的患者动脉瘤也得到很好的夹闭。结论大部分突向内侧的大中型床突旁动脉瘤可以在不磨除前床突的情况下通过跨血管得到很好的夹闭,而小型内侧型床突旁动脉瘤可以采用对侧翼点入路实行夹闭。

Objective To study the characteristics of medial paraclinoid aneurysm and apply it to microsurgery. Methods Retrospective study on 31 cases of medial paraclinoid aneurysm from Jan. 2008 to Jan. 2011 in Beijing Xuanwu Hospital was done, analyzing the anatomical features of the aneu- rysm and the relationship with the surrounding tissue, in order to clip the aneurysm in the smallest wound. Results Twenty patient＇s aneurysms were well clipped without grinding the anterior clinoid only opening part of the optic nerve sheath aneurysm. In these 20 patients only one patient had deterio- ration of eyesight, one patient had temporal lobe infarction three days after operation. The anterior clinoids were ground in need of surgical exposure in six patients. In these six patients three patients had the oculomotor paralysis of different degrees, one patient had deterioration of eyesight, the remaining two didn＇t have obvious complications. Five patient＇s aneurysms were well clipped from the opposite pterion approach. Conclusion The majority of middle and large medial paraclinoid aneurysms can be well clipped without grinding the anterior clinoid by cross-vascular clipping. The small medial paraclinoid aneurysm can be well clipped from the opposite pterion approach.