大脑前动脉远段动脉瘤的显微外科治疗

Microsurgical treatment of the distal anterior cerebral artery aneurysms

目的探讨大脑前动脉远段动脉瘤（DACAA）的显微外科治疗技术。方法回顾性分析16例DACAA病例资料。采用CTA和（或）DSA诊断，16例病人共发现20个动脉瘤，其中多发动脉瘤4例。均采用显微夹闭手术治疗，术中解剖纵裂，不临时阻断载瘤动脉，夹闭动脉瘤颈19个，烧灼切除1个。结果无手术死亡病例，术后出现脑积水2例，经持续腰大池引流后逐渐缓解。CTA显示动脉瘤完全夹闭17个，夹闭不全3个；载瘤动脉闭塞3例。术后随访6-24个月，平均随访12个月，动脉瘤复发1例。按GOS评估预后，恢复良好14例，轻度残疾2例。结论显微外科手术治疗DACAA安全有效，但存在一定手术风险．包括动脉瘤夹闭不全及载瘤动脉闭塞。

ObjeeUve To investigate the microsurgical treatment technology for distal anterior cerebral artery aneurysms （DACAAs）. Methods The clinical data of 16 patients with DACAA were analyzed retrospectively. All the cases were diagnosed on a basis of computed tomography angiography （CTA） or digital subtraction angiography （DSA）. These patients had a total of 20 DACAAs, including 4 multiple aneurysms in 4 patients. All the patients underwent microsurgical treatment. The longitudinal fissure was dissected without temporarily blocking the parent vessel. The neck of 19 aneurysms was microsurgically clipped and only one was excised by cauterizing. Results No patients died from operation. Only 2 patients incurred hydrocephalus, which was cured by continuous lumbar cerebral spinal fluid drainage. The follow-up CTA indicated that 17 aneurysms were clipped completely, 3 clipped partially and the artery was occluded in 3 patients. The follow up lasted from 6 to 24 months, the average follow-up time was 12 months and there was recurrence in 1 case. According to the Glasgow Outcome Scale, 14 patients were in good recovery and 2 patients had mild disability. Conclusions The microsurgical treatment of DACAA is safe and effective, but may bring some risks, including incomplete clipping ofaneurysm and unexpectedly occlusion of the parent artery.