微骨孔入路治疗颅内前循环动脉瘤的临床研究

Treatment of intracranial anterior circulatory aneurysms via keyhole approach

目的 探讨微骨孔入路微创外科技术治疗颅内前循环动脉瘤的临床效果。方法 采用经微骨孔入路对 5 3例颅内前循环动脉瘤实施手术治疗。其中翼点微骨孔入路夹闭颈内和大脑中动脉动脉瘤 37例 ,单侧额部纵裂微骨孔入路夹闭前 前交通动脉动脉瘤 16例。骨瓣宽 2 5～ 30mm ,高15～ 2 0mm ,应用高速钻开颅 ,经侧裂或纵裂暴露动脉瘤。结果 成功夹闭前循环动脉瘤 5 3例 ,其中切除瘤体 5例 ,12例动脉瘤术中破裂。术后造影动脉瘤闭塞 ,术后无死亡 ,术后并发症发生率为3 8% ,无与开颅入路相关的并发症。结论 微骨孔入路夹闭颅内前循环动脉瘤 ,可降低手术医源性损伤并获得最佳手术效果。

Objective To evaluate the clinical effect of treatment of intracranial anterior circulatory aneurysm via the minimum invasive surgical technique keyhole approach. Methods Fifty three patients with intracranial anterior circulatory aneurysms were operated upon via keyhole approach from February to November 2000, 37 cases with ICA or MCA being operated upon via pterional approach, and 16 cases with AcoA or ACA aneurysms via frontal unilateral interhemispheric keyhole approach. A bone flap, 25～30 mm wide and 15～20 mm high, was created with a high speed drill in craniotomy. The aneurysm was exposed through the lateral cerebral fissure or intercerebral fissure. Results The intracranial anterior circulatory aneurysms in 53 cases were successfully clipped via keyhole approach, of which 5 aneurysm bodies were resected and 12 cases underwent intraoperative accidental rupture. Postoperative angiography showed that all of the aneurysms were occluded. None of the cases died after operation. The morbidity of postoperative complication was 3.8%. No approach related complication occurred. Conclusion Keyhole approach helps to obtain the best operative effect for treatment of intracranial anterior circulatory aneurysm.