额下基底部纵裂入路显微外科手术治疗破裂的前交通动脉瘤

Subfrontal-basal interhemispheric approach for ruptured anterior communicating artery aneurysms

目的 对翼点入路处理前交通动脉瘤这一经典术式进行改良 ,形成所称的额下基底部纵裂入路 ,以减少术后“前交通动脉瘤综合症”的发生机会。方法 采用A1优势侧的眶 翼点入路 ,控制近端A1后 ,解剖基底纵裂池数厘米 ,在保留直回的情况下 ,可满意地暴露并安全地夹闭动脉瘤。结果 本组中 6 3%的患者 1年后的韦氏成人智能评分大于 90。结论 眶 翼点入路结合基底纵裂池的打开 ,可减轻术中脑牵拉并从解剖上保留直回 。

Objective The standard pterional approach was modified to so called subfrontal basal interhemispheric approach, in dealing with the ruptured AcomA aneurysms to diminnish the occurrence of the AcoA aneurysm syndrome postoperatively. Methods An orbital pterional craniotomy was made on the side where the A1 flow was dominant on angiograms. After an adequate control of proximate Al, the basal interhemispheric fissure was dissected for several centimeters, the AcomA aneurysm can be exposed fully and obliterated without removal of the rectal gyrus.Results Twenty of 32 patients(63%) presented with the excellent result (WAIS>90) 3 months after the operation.Conclusions With the aid of orbital pterional approach combined with opening of basal interhemispheric fissure, brain retraction can be reduced significantly and the rectal gyrus can be preserved. Consequently this techniaque lead to improved cognitive functions in patients with AcomA aneurysm after operation.