非优势A1侧翼点入路夹闭破裂前交通动脉瘤的临床研究

Clinical study of clipping ruptured anterior communicating aneurysms via contralateral pterional-craniotomy of dominant A1

目的比较非优势A1侧翼点开颅与优势A1侧翼点开颅夹闭破裂前交通动脉瘤的效果,并探讨其相关适应证。方法回顾性分析江西省人民医院神经外科自2013年9月至2019年9月存在优势A1现象的58例破裂前交通动脉瘤患者的临床资料。其中32例采用非优势A1侧翼点开颅,为非优势A1侧组;26例采用优势A1侧翼点开颅,为优势A1侧组;比较2组患者的显微镜下操作时间,夹闭方式(简单夹闭、复杂夹闭),术后3个月及1年的动脉瘤残留或复发情况,术后1年GOS评分等指标。结果非优势A1侧组简单夹闭25例,复杂夹闭7例;优势A1侧组简单夹闭12例,复杂夹闭14例,2组比较差异有统计学意义(χ2=5.148,P=0.022)。非优势A1侧组的显微镜下操作时间为(1.57±0.32)h,术后3个月动脉瘤残留或复发有2例(6.25%)、3例(9.38%),术后1年预后良好率为90.63%;优势A1侧组的显微镜下操作时间为(1.63±0.37)h,术后3个月动脉瘤残留或复发有2例(7.69%)、2例(7.69%),术后1年预后良好率为92.31%;2组比较差异均无统计学意义(P>0.05)。结论采用非优势A1侧翼点开颅夹闭前交通动脉瘤能够易化动脉瘤颈显露过程并简化夹闭方式,但需严格把握手术指征。

Objective To compare the effect of clipping ruptured anterior communicating aneurysms between contralateral pterional-craniotomy of dominant A1 and dominant A1 lateral pterional-craniotomy,and explore the surgical indication.Methods The clinical data of 58 patients with ruptured anterior communicating aneurysms who underwent pterional-craniotomy clipping in Neurosurgery Department of Jiangxi Provincial People’s Hospital from September 2013 to September 2019 were reviewed.Among them,32 cases were treated with contralateral pterional-craniotomy of dominant A1(the dominant A1 group)and 26 cases with dominant A1 lateral(the dominant A1 lateral group).The operation time under the microscope,clipping mode(simple clipping,compound clipping),the residual or recurrent of the aneurysm at 3 months and 1-year post-operation,and GOS score at 1-year post-operation were statistically analyzed.Results In the contralateral pterional-craniotomy of the dominant A1 group,a simple clipping was performed in 25 cases and compound clipping in 7 cases,while 12 cases and 14 cases respectively in the dominant A1 lateral group,and there was a significant difference between the two groups(χ2=5.148,P=0.022).The microscopical duration of surgery of the dominant A1 lateral group was(1.57±0.32)h,2 cases(6.25%)and 3 cases(9.38%)had aneurysm residual or recurrence 3 months after operation,and the 1-year good prognosis rate was 90.63%;those of the dominant A1 group were(1.63±0.37)h,2 cases(7.69%),2 cases(7.69%)and the 1-year good prognosis rate was 92.31%;there was no significant difference between the two groups(P>0.05).Conclusion Clipping anterior communicating aneurysms with a contralateral pterional-craniotomy of dominant A1 can facilitate the process of aneurysm neck exposure and simplify the clipping method,and surgeons must comply with a strict requisition for surgical indication.