纵裂翼点入路处理上突型前交通动脉动脉瘤

Microsurgery through pterional approach combined with longitudinal fissure approach for superior anterior communicating artery aneurysms

目的 提高上突型前交通动脉动脉瘤的显微手术疗效.方法 采用纵裂翼点入路处理18例上突型前交通动脉动脉瘤.术中采用半冠状切口,骨窗要求既要便于暴露外侧裂又要使单侧额部骨窗尽量低,以利于经额底纵裂入路行动脉瘤夹闭术.结果 本组共18例上突型前交通动脉动脉瘤,其中后上突型10例,后突型8例,术前Hunt-Hess分级Ⅰ级5例,Ⅱ级8例,Ⅲ级3例,Ⅳ级2例.18例均采用经纵裂翼点入路一次性完全夹闭.随访6 ～18个月,按GOS预后评分,5分16例,4分2例,其中3例记忆力略有下降,2例有轻度单侧肢体运动障碍.结论 纵裂翼点入路具有手术视野好,对额叶脑组织损伤小等特点,能较好暴露上突型尤其是后突型前交通动脉动脉瘤.

Objective To improve the efficacy of pterional approach combined with longitudinal fissure exposure for superiorly protruding anterior communicating artery aneurysms （ACoAA）.Methods Eighteen patients with superior ACoAA underwent microsurgery through the pterional approach combined with longitudinal fissure approach.The skull base should be fully exposed with proper coronal incision.Results Totally 18 patients with superior ACoAA were studied,including posterior-superior type,for 10 and anterior-superior type for 8.According to Hunt-Hess grading scale,patients were classified into Ⅰ grade （5 cases）,Ⅱ （8 cases）,Ⅲ （3 cases） and Ⅳ （2 cases）.All of the patients underwent the pterional approach combined with longitudinal fissureexposure by aneurysm clipping surgery and all of the aneurysms were completely clipped.The patients were followed up for 6-18 months postoperatively.Their Glasgow outcome scale （GOS） were 5 score in16 cases and 4 score in 2 cases.Memory deterioration was found in 3 cases,minor hemiplegia was found in 2 cases.Conclusions Treating superiorly protruding ACoAA through the have the advantage of good operating field exposure and less damage of frontal lobe.For superior ACoAA,especially for the posterior-superior type,the pterional approach combined with longitudinal fissure exposure provides a good surgical exposure and less frontal brain harassment.