经单侧翼点入路手术治疗前循环双侧多发动脉瘤的临床分析

Clinical analysis of the treatment of multiple aneurysms on both sides of the anterior circulation via unilateral pterional approach

目的探讨经单侧翼点入路显微手术治疗前循环双侧多发动脉瘤的临床效果及安全性。方法回顾性分析2015年1月至2019年12月于川北医学院附属医院神经外科行单侧翼点入路显微手术夹闭的53例前循环双侧多发动脉瘤患者的临床资料。53例患者共132个动脉瘤, Hunt-Hess分级为Ⅰ~Ⅳ级。通过术中夹闭情况和术后并发症评价手术的安全性;术后行临床随访, 采用格拉斯哥预后评级(GOS)评估患者的预后。结果 132个动脉瘤中, 术中成功夹闭动脉瘤129个, 3个开颅侧对侧未破裂动脉瘤行自体筋膜包裹加固处理。术后发生颅内感染5例(9.4%), 脑积水10例(18.9%), 再出血2例(3.8%), 迟发性脑缺血19例(35.8%), 严重激素或电解质紊乱6例(11.3%)。出院时预后良好(GOS Ⅳ、Ⅴ级为预后良好)者44例(83.0%), 术后3个月预后良好者49例(92.4%)。住院时间为(17.4±5.7)d(范围为11~36 d), 治疗费用为(7.5±1.7)万元(范围为6.0~16.8万元)。出院患者的满意率为94.3%(50/53)。结论部分前循环双侧多发动脉瘤可采用经单侧翼点入路显微手术治疗。通过严格的术前评估、合理的手术预案以及恰当的显微操作, 可获得较满意的治疗效果, 术后并发症较少。

Objective To explore the clinical effect and safety of microsurgery through unilateral pterional approach in the treatment of multiple aneurysms on both sides of the anterior circulation.Methods A retrospective analysis was conducted on the clinical data of 53 patients with multiple aneurysms on both sides of the anterior circulation who underwent microsurgical clipping via the unilateral pterional approach at the Department of Neurosurgery of the Affiliated Hospital of North Sichuan Medical College from January 2015 to December 2019.There were 132 aneurysms in 53 patients,and the Hunt-Hess grades were from Ⅰ to Ⅳ.The safety of the operation was evaluated by intraoperative clipping and postoperative complications.Postoperative clinical follow-up was performed and the Glasgow Outcome Scale(GOS)was used to evaluate the outcome of the patients.Results Among the 132 aneurysms,129 were successfully clipped during the operation,and 3 contralateral unruptured aneurysms were treated with autogenous fascia wrapping and reinforcement.Postoperative intracranial infection occurred in 5 cases(9.4%),hydrocephalus in 10 cases(18.9%),rebleeding in 2 cases(3.8%),delayed cerebral ischemia in 19 cases(35.8%),severe hormonal or electrolyte imbalance in 6 cases(11.3%).At discharge,44 cases(83.0%)had a good outcome(defined as GOS Ⅳ and Ⅴ);49 cases(92.4%)had a good outcome at 3 months after operation.The length of hospital stay was 17.4±5.7 days(range:11-36 days),and the treatment cost was 75±17 thousand yuans(range:60-168 thousand yuans).The satisfaction rate of discharged patients was 94.3%(50/53).Conclusions A subset of bilateral multiple aneurysms of the anterior circulation can be treated with microsurgery via unilateral pterional approach.Through strict preoperative evaluation,reasonable surgical plans and appropriate micromanipulations,satisfactory treatment results can be obtained with fewer postoperative complications.