眶上锁孔神经内镜下前循环动脉瘤夹闭手术

Neuroendoscopic clipping of intracranial aneurysms of anterior circulation via supraorbital keyhole approach

目的探讨眶上锁孔入路神经内镜下夹闭前循环动脉瘤的可行性及其临床意义。方法对13例前循环动脉瘤病人经眉弓小切口眶上锁孔入路进行夹闭手术,全程应用神经内镜。13例病人中,男性,8例,女性,5例;年龄:43～71岁。13例病人共14个动脉瘤,3个后交通动脉瘤,7个前交通动脉瘤,4个大脑中动脉瘤。3个未破裂动脉瘤,11个破裂动脉瘤。根据病人手术前的临床表现进行Hess-Hunt分级:1级2例;2级10例,3级1例。结果手术中均能广视角显露动脉瘤、载瘤动脉及周围的走行血管,无误夹闭、载瘤动脉狭窄及夹闭不全情况发生。结论眶上锁孔入路可以提供充分的手术空间,神经内镜下夹闭前循环动脉瘤,可以广视角观察动脉瘤及其周围的解剖结构,提高颅内动脉瘤的手术效果。

Objective To investigate the feasibility and clinical significance of clipping of intracranial aneurysm of anterior cireulation under neuroendoscopy through supraorbital keyhole approach. Methods Thirteen patients underwent clipping of anterior circulation aneurysrns under endoscope via supraorbital keyhole approach were analyzed. In this cohort of patients, there were 8 males and 5 females with age ranging from 43 to 71 years old. And 14 aneurysms of t3 patients included 3 posterior comrramicating aneurysms （PCoA）, 7 anterior corranunicating aneurysres （ACoA）, and 4 middle cerebral artery aneurysms （MCA）. Among 14 aneurysms there were 3 unruptured and 11 ruptured aneurysms. According to Hunt-Hess grading at admission, there were 2 cases of grade 1,10 cases of grade Ⅱ, 1 case of grade Ⅲ. Results All aneurysms and aneurysm-related peripheral blood vessels were fully exposed with expanded view under neuroendoscope. There were no case of wrong clipping and insufficient clipping of aneurysm. Conclusion Neuroendoscope can provide a broad visual field for aneurysm clipping. Full endoscopic procedure for aneurysm clipping could be a safe and effective application to increase the quality of treamaent.