眶上外侧入路治疗急性期破裂大脑中动脉动脉瘤的经验体会

Experience of treatment of acute ruptured middle cerebral artery aneurysms by lateral supraorbital approach

目的探讨眶上外侧入路(LSO)治疗急性期破裂大脑中动脉(MCA)动脉瘤的有效性和安全性。方法回顾性分析48例MCA动脉瘤患者的临床资料。以Hunt-Hess分级Ⅰ~Ⅲ级、改良CT Fisher分级Ⅱ~Ⅲ级为入选标准,手术均采用LSO行MCA动脉瘤夹闭术。患者术后随访1年,采用格拉斯哥预后量表(GOS)评价手术效果。结果48例患者动脉瘤全部成功夹闭。GOS评估结果显示,V级(恢复正常工作)40例,Ⅳ级(轻残)8例。结论采用LSO显微手术治疗急性破裂MCA动脉瘤效果良好,但其有效性和安全性仍需扩大样本量和长时间随访进一步证实。

Objective To explore the efficacy and safety of lateral supraorbital approach(LSO)in treatment of acute ruptured middle cerebral artery(MCA)aneurysm.Methods The clinical data of 48 patients with MCA aneurysm were retrospectively analyzed.The Hunt-Hess gradeⅠtoⅢand the modified CT Fisher gradeⅡtoⅢwere selected as selection criteria for these patients.The LSO was used and MCA aneurysm clipping was performed.Patients were followed up for one year,and the outcome of surgery was evaluated by Glasgow Outcome Scale(GOS).The follow-up period was one year,and the effect of the operation was evaluated by the Glasgow Outcome Scale(GOS).Results Aneurysms were successfully clipped in all 48 patients.GOS results showed that 40 cases were grade V(recovery of normal working)and 8 cases were gradeⅣ(mild disability).Conclusion LSO microsurgery for acute ruptured MCA aneurysms is effective,but its efficacy and safety need to be further confirmed by larger sample size and long-term follow-up.