经对侧翼点入路夹闭床突旁动脉瘤及伴发的颅内动脉瘤的手术探讨

Clipping of paraclinoid aneurysms associated with multiple and bilateral aneurysms through contralateral pterional approach

目的 探讨对侧翼点入路夹闭床突旁动脉瘤的可行性及手术技巧.方法 回顾性分析2012年1月至2015年1月北京安贞医院神经外科和北京天坛医院神经外科,经对侧翼点入路手术夹闭合并床突旁动脉瘤的双侧多发动脉瘤9例患者的临床资料,患者年龄41~64岁,平均50.6岁,总结手术特点及预后.结果 对侧翼点入路手术夹闭合并床突旁动脉瘤的双侧多发动脉瘤,共20个动脉瘤,包括切口对侧床突旁动脉瘤9个,同侧颈内动脉末端动脉瘤4个,后交通动脉瘤4个,前交通动脉瘤2个,大脑前动脉瘤1个.术后CT血管造影示所有动脉瘤消失,载瘤动脉通畅.术后无新发视力缺损,1例患者嗅觉下降;1例出现脑梗死;1例术前存在视力下降患者,随访发现视力较前好转,余患者情况良好.结论 经对侧翼点入路夹闭指向内侧的床突旁动脉瘤是可行和有效的.对于合并此类型床突旁动脉瘤的双侧多发动脉瘤,选择手术入路夹闭其他动脉瘤时,可考虑经对侧一次手术夹闭所有动脉瘤.

Objective To investigate the minimally invasive techniques and the indication of paraclinoid aneurysms associated with other aneurysms′clipping via the contralateral approach.Methods From January 2011 to January 2015, 9 paraclinoid aneurysms associated with other aneurysms were clipped via contralateral approach at the Department of Neurosurgery , Beijing Tiantan Hospital .The records of these patients were analyzed retrospectively to review the clinical outcome and surgical skills .Results A total of 20 multiple bilateral aneurysms (9 of contralateral paraclinoid aneurysms , 4 of ICA aneurysms , 4 of posterior communicating artery aneurysms , 2 of anterior communicating artery aneurysms and 1 of anterior cerebral artery aneurysm ) from 9 patients were clipped successfully through a unilateral pterional craniotomy .All patients with paraclinoid aneurysms who underwent surgery through contralateral approach showed a good recovery.Postoperative digital subtraction angiography or computerized tomography angiography did not show any residual aneurysm.One patients had ipsilateral olfactory nerve injury during operation .One had cerebral ischemia after surgery , and other patients discharged uneventfully .Of the 1 patients with preoperative visual symptoms showed an improvement .No visual function impairment was observed among others .Conclusions The contralateral approach remains a safe and reliable treatment option for medial directed paraclinoid aneurysms and those associated with bilateral intracranial aneurysms .For bilateral multiple aneurysms associated this kind of paraclinoid aneurysms , consideration may be given to clipping all aneurysms with the contralateral approach .