经小翼点入路夹闭大脑中动脉分叉部动脉瘤

Clipping of Middle Cerebral Artery Bifurcation Aneurysms via Minipterional Aapproach

目的探讨经小翼点入路(MPT)夹闭大脑中动脉分叉部动脉瘤(MbifA)的效果及策略。方法回顾性分析41例2010至2015年经MPT夹闭MbifA患者的临床资料。结果41例经MPT夹闭MbifA后,瘤颈残余1例,术后并发症5例,血管痉挛1例;无颞肌、面神经功能障碍。GOS评分:出院时恢复良好(GOS 4~5分)32例,恢复不良(GOS2~3分)9例,死亡(GOS 1分)0例。远期随访:恢复良好35/41例(85%),恢复不良6/41例(15%),脑积水6例;无复发及再出血病例。结论经MPT夹闭MbifA安全、有效,损伤小、操作快,适合作为常见MbifA夹闭手术入路。

Aim To summarize the outcome and strategies of clipping surgery of middle cerebral artery bifurcation aneurysms（MbifA） via minipterional approach（MPT）. Methods Clinical Data of 41 clipping surgery of MbifA via MPT in department of neurosurgery from January 2010 to December 2015 were analyzed retrospectively. Results Among all cases,1 case required another surgery for the remnant aneurysm, 5 cases of postoperative complications were reported, with no temporalis or facial nerve dysfunction. 1 case of vasospasm was reported. According to the GOS evaluation, 32 cases got well outcome（GOS 4～5） while 9 got poor outcome（GOS 2～3）, with no death case（GOS 1） reported. In follow-up from 6 to 60 months, 35 cases got well outcome while 6 got poor outcome. 6 cases of hydrocephalus were reported. No case of reoccurrence or rebleeding was reported. Conclusion Clipping surgery of MbifA via MPT is safe, efficient, little invasive and fast. It is appropriate for most common MbifA.