经翼点小骨窗入路治疗前循环颅内动脉瘤患者临床疗效分析

Pterional keyhole approach in surgical treatment of ruptured anterior circulation intracranial aneurysm:a report of 313 cases

目的：总结分析经翼点小骨窗入路手术治疗前循环颅内动脉瘤的效果、手术技巧及经验。方法：收集2009年1月至2014年6月期间在浙江大学医学院附属第二医院神经外科采用经翼点小骨窗入路手术治疗前循环颅内动脉瘤的313例患者的临床资料，计算动脉瘤完全夹闭率、术后并发症发生率，术后随访6个月并采用改良Rankin评分评估患者预后。结果：治疗313例患者共处理348个动脉瘤，其中术中完全夹闭326个、包裹6个，术后瘤颈残留16个，完全夹闭率为93．7％；术后发生迟发性脑缺血15例（4．79％）、慢性脑积水10例（3．19％）；随访结果，预后良好209例（66．77％），预后不良93例（29．71％），死亡11例（3．52％）。结论：经翼点小骨窗入路可以处理多数类型的前循环动脉瘤。采用该手术方式较标准翼点入路方式术中动脉瘤夹闭率相近，术后并发症发生较少，患者恢复较快，预后较好。

Objective： To review the surgical modality with pterional keyhole approach in treatment of anterior circulation aneurysm. Methods： Three hundred and thirteen patients with ruptured anterior circulation intracranial aneurysm treated surgically with pterional keyhole approach between January 2009 and June 2014 in Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, were included in the analysis. Complete occlusion rate of aneurysms and incidence of major complications including delayed cerebral isehemia and chronic hydrocephalus were documented. Surgical outcomes at 6-month follow up were assessed by modified Rankin Scale. Results： Totally 348 aneurysms were treated with pterional keyhole approach, 326 aneurysms were completely clipped, 16 aneurysms were partly clipped, and 6 aneurysms were wrapped with gauze material. Among 313 patients, 15 patients （4.79%） suffered from delayed cerebral ischemia, and 10 patients （3.19%） suffered from hydrocephalus. At the 6-month follow up, the rate of good outcome was 66.77% （209/313）. Conclusions： The pterional keyhole approach can be used to clip most of anterior circulation aneurysms, and it seems to have advantages over the traditional approaches with lower incidence of complications and similar outcomes.