脑动脉瘤手术中穿通支的损伤及其并发症

Damages of perforating arteries and related complications resulted from the clippingof cerebral aneurysms

目的研究脑动脉瘤夹闭术中载瘤动脉及穿通支损伤对脑动脉瘤预后的影响,探讨减少并发症的方法。方法以施行开颅脑动脉瘤夹闭术治疗的52例病人为研究对象,分析术中载瘤动脉及其穿通支损伤与术后并发症的关系。结果发现脑动脉瘤57个。有载瘤动脉及穿通支损伤9例,其中术中破裂4例。大脑前动脉穿通支损伤4例,引起失语、偏瘫,出现严重的脑水肿、脑疝;大脑中动脉穿通支损伤3例,引起肢体活动不灵;前脉络膜动脉损伤2例,引起下肢为重的偏瘫、失语和意识障碍。结论脑动脉瘤开颅夹闭术中易引起载瘤动脉及其穿通支的损伤,应在显微镜下充分解剖蛛网膜下腔,避免在解剖关系不清的状态下盲目操作。

Objective To study the effect of perforating artery damages during aneurysms clipping operation on the prognosis of intracranial aneurysms. Methods 52 surgically treated patients were reviewed. All patients presented with subarachnoid hemorrhage. The relationship between post-operative complications and damages of parent arteries or perforating arteries was analyzed. And the methods of reducing these damages were also discussed. Results 57 aneurysms were found in 52 patients. 9 patients had the damages of parent arteries or perforating arteries, and 4 of them underwent intraoperative rupture. 4 patients suffered from damages of perforating arteries from anterior cerebral arteries, with aphemia, palsy, severe cerebral edema and herniation. Middle cerebral artery damages existed in 3 patients with limited abilities of limbs. Leg palsy, aphemia or disturbance of consciousness were observed in 2 cases of anterior choroid artery injury. Conclusion Intracranial aneurysms neck clipping damaged parent arteries or perforating arteries easily. Consideration should be given to the wide opening of arachnoid membrane under a microscope, avoiding operating blindly, which is no doubt critical to the prognosis of intracranial aneurysms.