纵裂入路与翼点入路夹闭前交通动脉瘤临床对比研究

Clinical comparative study between the interhemispheric approach and the pterional approach in craniotomy anterior communicating aneurysm clipping surgery

目的回顾性分析比较经纵裂入路与翼点入路在开颅前交通动脉瘤夹闭术的临床疗效。方法选取中国医科大学附属盛京医院神经外科2012年1月至2016年12月共21例前交通动脉瘤破裂继发蛛网膜下腔出血开颅动脉瘤夹闭患者，均为同一术者实施手术，其中13例患者行翼点入路前交通动脉瘤夹闭术，8例患者行纵裂入路前交通动脉瘤夹闭术，比较两种手术入路方式在手术时间、术中动脉瘤破裂发生率、术中出血量、住院时间、术后感染发生率及患者出院时格拉斯哥预后评分（GOS）差异。结果两种手术方式在术中动脉瘤破裂发生率、术中出血量、术后感染发生率及患者出院GOS评分方面比较差异无统计学意义（P〉0．05），纵裂入路对比翼点入路手术时间及患者术后住院时间更短（P〈0．05）。结论纵裂入路是安全有效、方便快捷的开颅夹闭前交通动脉瘤手术入路之一。

Objective To retrospectively analyze and compare the intraoperative and postoperative clinical efficacies between the interhemispheric approach and pterional approach in craniotomy anterior communicating aneurysm clipping surgery. Methods A total of 21 cases of anterior communicating artery an- eurysms with subarachnoid hemorrhage undergoing surgery of craniotomy clipping from January 2012 to December 2016 in the Department of Neurosurgery of Shengjing Hospital of China Medical University, in which 13 cases were treated by pterional approach and 8 cases were treated by interhemispheric approach. Two kinds of operation approaches were compared in operation time, intraoperative aneurysm rupture rate, intraoperative bleeding volume, average length of stay, incidence rate of postoperative fection, and Glasgow Outcome Scale （GOS）. Results There were no significant difference in intraoperative aneurysm rupture rate, intraoperative bleeding volume, inicidence rate of postoperative infection rate, and GOS scores （ P 〉 0. 05 ）. But the opreration time and average length of stay in interhemispheric approach group were significantly shorter than the pterional approach group （P 〈 0. 05 ）. Conclusions Approach of interhemispheric was a safe, effective, and convenient approach for the craniotomy of clipping in anterior communicating artery aneurysm.