经眉弓眶上锁孔入路夹闭前循环动脉瘤

Clipping of anterior circulation aneurysms by supraorbital keyhole through an eyebrow incision

目的探讨经眉弓眶上锁孔入路夹闭前循环动脉瘤的治疗效果。方法收集2012年10月至2015年7月于我科行经眉弓眶上锁孔入路夹闭前循环动脉瘤的61例患者,其中Hunt-Hess分级Ⅰ级23例,Ⅱ级21例,Ⅲ级14例;大脑中动脉瘤9例,后交通动脉瘤14例,前交通动脉瘤30例,多发动脉瘤8例。一期完全夹闭动脉瘤60例,二期夹闭对侧大脑中动脉瘤1例。结果手术效果良好,术后疤痕小,切口相关并发症少。经该术式夹闭71个前循环动脉瘤,包括8例多发动脉瘤患者。随访有98.3%的患者恢复良好,轻残1例。结论经眉弓眶上锁孔入路是夹闭前循环动脉瘤的微创、安全有效的入路,术前谨慎选择患者及充分手术经验和操作技巧是手术成功的保证。

Objective The effect of the supraorbital keyhole craniotomy through an eyebrow incision for anterior circulation aneurysms was discussed. Methods From October 2012 to July 2015, 61 patients with anterior circulation aneurysms were operated on via supraorbital keyhole craniotomy through an eyebrow incision, including 9 middle cerebral artery aneurysms,14 posterior communicating artery aneurysms, 30 anterior communicating artery aneurysms, and 8 multiple intracranial aneurysms. According to Hunt-Hess grades, 23 were Grade I, 21 were Grade Ⅱ, and 44 were Grade Ⅲ. One-stage surgeries were performed in 60 patients, two-stage operations were performed in 1 case in order to clip a middle cerebral artery aneurysm in the other side. Results There was a good surgical result with less approach-related complications. A total of 71 anterior circulation aneurysms were clipped successfully, including 8 cases of multiple aneurysms. INning the follow-up, 98. 3% cases got good recovery and 1 case of mild disability. Conclusion Supraorbital keyhole craniotomy through an eyebrow incision is a minimal invasive and safe approach for selected anterior circulation aneurysms based on good microsurgical experience and skills.