前床突切除处理床突旁动脉瘤

Anterior clinoidectomy for the management of paraclinoid aneurysms

目的 探讨前床突切除处理床突旁动脉瘤的手术技巧和临床疗效.方法 回顾分析2010年1月至2014年7月25例采用前床突切除术治疗床突旁动脉瘤患者的临床资料.25例中,男6例,女19例,平均年龄51.4岁.6例为多发动脉瘤.8例动脉瘤破裂,17例动脉瘤未破裂.床突旁动脉瘤大小：6个小于5 mm,13个位于5～15 mm,6个大于15 mm.所有患者均行翼点入路硬膜下磨除前床突,9例动脉瘤直接夹闭,16例行动脉瘤夹闭塑形.随访中复查脑血管造影（DSA）并用格拉斯哥结局量表（GOS）评估疗效.结果 术后DSA提示2例留有残颈,2例载瘤动脉狭窄.所有患者随访1 ～51个月（平均22.5个月）,10例预后好（GOS 5分）,13例轻度残疾（GOS 4分）,2例重度残疾（GOS 3分）.结论 磨除前床突,开放视神经管上壁,分离出床突段颈内动脉,能为显露和夹闭动脉瘤提供更好的术野,提高手术治疗床突旁动脉瘤的安全性和疗效.

Objective To investigate the surgical skills and clinical efficacy of anterior clinoidectomy for the management of paraclinoid aneurysms.Methods The clinical data of 25 patients with paraclinoid aneurysm treated with anterior clinoidectomy from January 2010 to July 2014 were analyzed retrospectively.Of the 25 patients,19 were females and 6 were males （mean age 51.4 years）.Six patients had multiple intracranial aneurysms,8 had ruptured aneurysms,and 17 had unruptured aneurysms.The size of paraclinoid aneurysms：6 were less than 5 mm,13 were 5 mm to 15 mm,and 6 were more than 15 mm.All the patients performed the removal of the anterior clinoid process in subdural space via pterional approach,9 aneurysms were clipped directly,and 16 were clipped and shaped.Postoperative digital subtraction angiography （DSA） was performed and the Glasgow outcome scale （GOS） was used to evaluate the efficacy during the follow-up period.Results Postoperative DSA indicated that 2 patients had residual aneurysm necks,and 2 had parent artery stenosis.All patients were followed up for 1 to 51 months （mean 22.5 months）.Ten patients had good prognosis （GOS 5）,13 had mild disability （GOS 4）,and 2 had severe disability （GOS 3）.Conclusion The removal of the anterior clinoid process,opening the superior wall of optic canal,and isolating the internal carotid artery of clinoid segment may provide better a surgical field for exposing and clipping aneurysms,and thus improve the safety and efficacy of surgical treatment of paraclinoid aneurysms.