单侧开颅夹闭双侧大脑中动脉镜像动脉瘤的疗效

Efficacy of unilateral craniotomy for clipping bilateral mirror aneurysms of the middle cerebral artery

目的探讨单侧开颅夹闭双侧大脑中动脉镜像动脉瘤的可行性与神经内镜应用价值。方法回顾性分析13例大脑中动脉镜像动脉瘤患者的临床资料;记录每个病例是否应用内镜、手术时间、术后3个月时对侧瘤颈有无残留、格拉斯哥预后评分(Glasgow outcome scale,GOS)。结果单侧开颅一期成功夹闭对侧动脉瘤9例,其中单纯显微镜下夹闭成功4例,内镜辅助显微镜下夹闭成功5例;一期手术失败需二期手术4例。在单侧开颅一期成功夹闭对侧动脉瘤中,术后3个月CTA提示对侧瘤颈无残留6例(其中单纯显微镜下夹闭2例、内镜辅助显微镜下夹闭4例),瘤颈残留3例(其中单纯显微镜下夹闭2例、内镜辅助显微镜下夹闭1例)。单纯显微镜手术时间为(171.0±9.2)min,内镜辅助显微镜为(179.3±6.6)min,采用神经内镜辅助手术时间无明显增加。术后3个月GOS:5分11例,4分2例。结论单侧入路夹闭双侧大脑中动脉镜像动脉瘤手术具有可行性,采用神经内镜辅助有助于提升手术疗效。

Objective To investigate the feasibility of unilateral craniotomy for clipping bilateral mirror aneurysms of the middle cerebral artery(MCA)and the value of neuroendoscopy in this procedure.Methods Clinical data of 13 patients with bilateral mirror aneurysms of the MCA were analyzed retrospectively.The use of endoscopy,operative time,presence of residual aneurysm neck on the contralateral side at 3 months postoperatively,and Glasgow Outcome Scale(GOS)scores were recorded for each case.Results Nine patients underwent successful clipping of the contralateral aneurysm in a single-stage unilateral craniotomy,including 4 under microscope alone and 5 with endoscope-assisted microsurgery.Four patients required a second-stage operation due to failure in the first-stage procedure.Among the successful single-stage unilateral craniotomy cases,postoperative computed tomography angiography(CTA)at 3 months revealed no residual aneurysm neck in 6 cases(2 under microscope alone and 4 with endoscopeassisted microsurgery),while 3 cases had residual aneurysm neck(2 under microscope alone and 1 with endoscope-assisted microsurgery).The operative time was(171.0±9.2)minutes for simple microsurgery and(179.3±6.6)minutes for endoscope-assisted microsurgery,indicating no significant increase in operative time with neuroendoscopy.The GOS scores at 3 months postoperatively were 5 in 11 cases and 4 in 2 cases.Conclusions Unilateral craniotomy for clipping bilateral mirror aneurysms of the MCA is feasible,and the use of neuroendoscopy can enhance surgical outcomes.