翼点锁孔入路治疗前交通动脉瘤

Microsurgical management of anterior communicating artery aneurysms via pterional keyhole approach

目的探讨翼点锁孔入路治疗破裂后前交通动脉瘤的手术技巧。方法对手术夹闭22例破裂前交通动脉瘤的临床资料进行回顾分析,以64排CTA为确诊手段,动脉瘤瘤顶指向在CTA分为5型,向前2例;向下2例;向上10例;向后5例;多方向3例。22例患者24个动脉瘤均行翼点锁孔入路手术夹闭,有3例患者手术夹闭后由于脑积水而行脑室腹腔分流术。结果出院时根据GOS判断预后:恢复优良17例,轻残3例,重残1例,死亡1例。结论翼点锁孔入路可以满足大多数前交通动脉瘤病例的手术要求。手术要根据动脉瘤顶的指向个性化区别对待。

Objective To explore microsurgical technique of ruptured anterior communicating artery aneurysms via pterional keyhole approach .Methods The clinical dada of 22 patients with ruptured anterior communicating artery aneurysms who received the surgical clipping were analyzed retrospectively .All patients were diagnosed by 64 rows helical CT angiography （ CTA ） .Aneurysm were classified with 5 major groups according to the dome projection .2 forward,2 downward,10 upward ,5 backward and 3 complex involvement .24 aneurysms were clipped in 22 patients via pterional keyhole approach . Ventriculoperitoneal shunting were performed in 3 cases with postoperative hydrocephalus .Results According to the Glasgow Outcome Scale （ GOS ） after discharge ,17 had good recovery ,3 mild disability ,1 severe disability and 1 died.Conclusions The pterional keyhole approach for anterior communicating artery aneurysms is technically viable . However ,it requires a individualized management according to the dome projection .