颞下锁孔入路手术治疗基底动脉顶端动脉瘤

目的探讨经颞下锁孔入路手术治疗基底动脉顶端动脉瘤的疗效及手术技巧。方法自2002年7月至2010年4月收治基底动脉顶端动脉瘤患者7例,均在神经内镜辅助下经颞下锁孔入路手术治疗。入院时Hunt-Huess分级0和1级各1例,Ⅱ级3例,Ⅲ和Ⅳ各1例。结果 6例完全夹闭,1例部分残留。无手术死亡病例;术后出现术侧动眼神经麻痹3例,均在6月内恢复。术后随访8月至6年,恢复工作或生活自理5例,一侧肢体偏瘫1例,植物生存1例。结论经颞下锁孔入路手术治疗基底动脉顶端动脉瘤效果良好,尤其对于动脉瘤瘤颈位于后床突下方或瘤体后突者;神经内镜是必不可少的辅助手段。

Microsurgery through subtemporal keyhole approach for basilar bifurcation aneurysms (a report of 7 cases)

Objective To explore the feasibility to clip the basilar bifurcation aneurysms by microsurgery through the subtemporal keyhole approach and the technical details related to it.Methods The clinical data of 7 patients with the basilar bifurcation aneurysms treated by endoscope-assisted microsurgery through the subtemporal keyhole approach from July,2002 to April,2010 were analyzed retrospectiely.The disease condition of 1 patient belonged in grade 0,1 in grade Ⅰ,3 in grade Ⅱ,1 in grade Ⅲ and 1 in grade Ⅳ according Hunt-Hess grading.The diameters in 5 aneurysms were less than 10 mm and the diameters in 2 aneurysms with wide-necks ranged from 11to 20 mm.Results Satisfactory clipping of the aneurysms was achieved in 6 patients.There was the partial neck remmant in 1 patients with wide-neck aneurysm.The fellowing up from 8 months to 6 years showed that of 7 patients,5 were recovered well,1 had hemiplegia and 1 vegetatively survived.No patient died.Conclusions It is feasible to clip the basilar bifurcation aneurysms by microsurgery through the subtemporal keyhole approach,which provides a better alternative for patients with basilar bifurcation aneurysms under the posterior clinoid process or projecting backwards in especial.The neuroendoscope is requisite for the microsurgery through the subtenporal keyhole approach in the patients with basilar bifurcation aneurysms.