翼点入路和眶-翼点入路处理前交通动脉瘤的定量解剖学对照研究

Quantitative anatomic comparison of pteral approach and orbital-pteral approach during clipping for anterior communicating artery aneurysms

目的对比翼点入路和眶-翼点入路处理前交通动脉瘤的显露范围和观察角度,做量化分析,为临床提供参考。方法应用6例(12侧)成年新鲜灌注尸头模拟手术入路操作,选择前交通动脉复合体为靶点,测量并统计分析显露范围和观察角度。结果翼点入路显露范围平均为(1.796±0.079)cm^(2),显露角度平均为(9.586±0.543)°。眶-翼点入路显露范围平均为(2.241±0.062)cm^(2),显露角度平均为(18.152±0.711)°。眶-翼点入路显露面积和显露角度均明显大于翼点入路(P<0.05)。结论对无颅内压增高、无脑肿胀、形态简单的前交通动脉动脉瘤,翼点入路是首选入路;但对于复杂前交通动脉动脉瘤如瘤体向下、向后突出以及呈分叶型等,眶-翼点入路手术可减少硬膜内牵拉,显露范围和角度更大,术中显微镜倾斜角度小,可减少脑组织的损害。临床上,建议根据术前含骨窗CTA或3D-DSA进行个体化选择手术入路。

Objective To compare the exposure range and the observation angle of clipping through pterygial approach and orbitopterygial approach for anterior communicating artery aneurysms and to provide reference for clinic.Methods Six(12 sides)adult fresh perfusion cadaveric heads were simulated by surgery through pterygial approach and orbito-pterygial approach for anterior communicating artery aneurysms.Anterior communicating artery complex was selected as the target.The exposure range and the observation angle were measured and analyzed statistically.Results The average exposure range and the average exposure angle of the pterygial approach were(1.796±0.079)cm^(2) and(9.586±0.543)°,respectively.The average exposure range and the average exposure angle of orbito-pterygal approach were(2.241±0.062)cm^(2) and(18.152±0.711)°,respectively.The exposure area and the exposure angle of orbito-pterygoid approach were significantly greater than those of pterygoid approach(P<0.05).Conclusions Pterygoid approach is the preferred approach for clipping anterior communicating artery aneurysms without increased intracranial pressure,brain swelling or simple morphology.However,for complex anterior communicating artery aneurysms,such as aneurysmal sac protruding downward and backward,and lobulated aneurysms,orbito-pterygal approach can reduce intradural pull,expose wider range and angle,and reduce intraoperative microscopic tilt angle,which can reduce brain tissue damage.Clinically,it is recommended to individually select surgical approaches based on preoperative CTA with bone window or 3D-DSA.