应用改良颅-眶颧入路处理高位前交通动脉瘤

Modified orbitozygomatic approach for high positioned anterior communicating artery aneurysm

目的介绍应用改良颅-眶颧入路处理高位前交通动脉瘤的操作方法和手术经验。方法采用“双瓣”技术,首先行额颞开颅,取下额颞骨瓣。然后采用“6次切割”法,用气锯分别锯断颧弓根部、颧突、外侧眶缘和外侧眶壁、眶上缘、眶顶,取下眶-颧骨瓣。然后进行硬脑膜内的显微外科动脉瘤夹闭术。结果本组8例全部采用改良颅-眶颧入路,明显缩短了手术操作距离,对深部的观察角度明显增大,可在避免切除直回的前提下手术夹闭前交通动脉瘤。术后CT复查未见明显的脑牵拉性损伤,未发生眼球凹陷、眼球损伤及颅神经损伤等并发症。结论改良颅-眶颧入路手术中没有骨质丢失,不需行眶顶重建,避免了术后眼球凹陷的发生。可从解剖上保留直回,避免了术后病人认知功能障碍。

Objective To introduce the operative methods and experience of the modified orbitozygomatic (OZ) approach for the high positioned anterior communicating artery (AcomA) aneurysm. Methods So-called 'two-flaps' technique was adopted for the modified OZ approach. Initially a frontotemporal bone flap was turned, followed by the 'six bone cuts' with pneumatic saw to divide the root of zygomatic process, malar eminence, lateral orbital rim, lateral orbital wall, superior orbital rim as well as the orbital roof. After the orbitozygomatic bone flap was freed, the intradural microsurgery will be preceded. Results Eight cases of high positioned AcomA aneurysms were explored via the modified OZ approach. The operating distance significantly decreased and the viewing-angle widened, with the anatomically preservation of gyrus rectus. There was no brain retraction injury demonstrated on CT scan in all cases, no evidence of enophthalmos as well as the damage to the eyeball and cranial nerves after surgery. Conclusion There is no bone loss in the modified OZ approach, obviating the need for bone reconstruction of the orbital walls in avoiding of the postoperative complication of enophthalmos. Moreover, it can avoid the postoperative cognitive dysfunction due to the anatomical preservation of gyrus rectus.