眶上外侧入路夹闭治疗前循环破裂动脉瘤

Clinical analysis of lateral supraorbital microsurgical approach for ruptured anterior circulation a neurysm

目的探讨眶上外侧入路治疗前循环破裂动脉瘤的安全性及有效性。 方法回顾性分析山东大学第二医院2016年2至12月手术治疗23例Hunt－Hess分级Ⅰ～Ⅲ级前循环破裂动脉瘤患者的术前症状、影像学资料、手术治疗及随访情况。 结果所有患者均经术前CT血管成像（CTA）或数字减影血管造影（DSA）证实为前循环动脉瘤。患者均接受眶上外侧入路手术夹闭动脉瘤，手术顺利，未出现手术相关并发症。随访2～12个月，格拉斯哥预后评分（GOS）5分18例（78.3%），4分2例（8.7%），3分2例（8.7%），1分1例（4.3%）。 结论通过眶上外侧入路可以充分暴露前循环动脉瘤，从而安全、有效地完成动脉瘤夹闭，该手术入路简便、创伤小，在熟练掌握翼点入路的前提下采用，可充分发挥其优势。

To explore the safety and efficiency of lateral supraorbital （LSO） approach for the ruptured anterior circulation aneurysm. MethodsThe clinical data of 23 patients with grade Ⅰ-Ⅲ ruptured anterior circulation aneurysm via LSO at the Second Hospital of Shandong University from February 2016 to December 2016 were retrospectively analyzed. The clinical data included their clinical manifestations, radiological finding, microsurgical techniques and follow-up results. ResultsAll patients were diagnosed as anterior circulation aneurysm by preoperative CT angiography （CTA） or Digital Subtraction Angiography （DSA）. They all accepted aneurysm clipping via LSO. The operations carried out smoothly, with no operation related complications. They were followed up for 2 to 12 months, and the Glasgow outcome scales （GOS） were 5 in 18 patients （78.3%）, 4 in 2 patients （8.7%）, 3 in 2 patients （8.7%）, and 1 in 1 patient （4.3%）. ConclusionLSO could provide adequate exposure for the anterior circulation aneurysm, so the clipping could be carried out safely and effectively. LSO is a simple and minimally invasive surgical approach, and when it is used by the skilled master of pterion approach, its advantage could be fully played.