显微外科治疗前交通动脉瘤手术入路的选择及疗效分析

Efficacy analysis and choice of microsurgical approaches for anterior communicating artery aneurysms

目的探讨显微外科标准翼点入路、纵裂入路和翼点纵裂联合入路治疗前交通动脉瘤的疗效,以及显微手术入路选择的原则。方法回顾性分析2012年1月~2015年6月保定市第二医院神经外科收治的78例前交通动脉瘤患者的临床资料和手术效果,术前均行头颅CTA或DSA检查确诊。疾病早期显微手术经翼点入路夹闭动脉瘤39例,经纵裂入路34例,联合入路5例。结果根据患者出院后6个月时的格拉斯哥预后量表（GOS）评分评估手术疗效,经翼点入路手术的患者中预后良好者29例,经纵裂入路患者中预后良好者25例,联合入路的5例患者均预后良好。结论早期显微手术经翼点入路、经纵裂入路及联合入路治疗前交通动脉瘤均有效且预后良好。根据不同的动脉瘤瘤体指向,合理地选择手术入路是手术成功的基础。

Objective To explore the efficacy of microsurgical standard pterional approach,interhemispheric approach and combined approaches for clipping anterior communicating artery aneurysms,and the principles for choosing microsurgical approaches. Methods The clinical data of78 patients with anterior communicating artery aneurysms treated in our hospital from January,2012 to June,2015 were analyzed retrospectively. All of the patients were diagnosed with CTA or DSA. 39 cases were treated by standard pterional approach,34 cases by interhemispheric approach and 5 cases by combined approaches. Results According to the Glasgow Outcome Scale,29 cases by standard pterion approach,25 cases by interhemispheric approach and 5 cases by combined approaches had good recovery at six months after hospital discharge. Conclusions Early treatment of anterior communicating artery aneurysms by standard pterional approach,interhemispheric approach and combined approaches is effective and has favorable prognosis. Choosing proper microsurgical approach according to aneurysm points is the basis of successful microsurgery.