单侧翼点入路一期治疗双侧后交通动脉动脉瘤的疗效分析

目的探讨经单侧翼点入路一期显微外科手术夹闭颅内双侧后交通动脉动脉瘤（BPcoAA）的可行性及手术效果。方法回顾性分析28例BPcoAA患者的临床资料，对所有患者均行头部CT扫描、三维CT血管成像（3D—CTA）检查。全部经一侧翼点入路行开颅显微外科手术夹闭BPcoAA。术后随访6个月至3年，复查头部3D—CTA及患者的一般情况，并以格拉斯哥预后（GOS）评分评估预后。结果（1）3D—CTA术前良好显示28例的56个动脉瘤，动脉瘤被完全夹闭的有24例，对侧动脉瘤夹闭不完全的有3例，入路侧动脉瘤夹闭不完全的有1例，无一例死亡。术中入路侧动脉瘤破裂的有8例。②术后7例出现脑积水，5例人路侧及3例对侧发生脑血管痉挛，3例发生肺部感染，2例对侧动眼神经损伤。③平均随访1．7年。GOS评分：5分10例，4分7例，3分9例，2分2例。无动脉瘤复发及新动脉瘤形成，动脉瘤夹闭不全者无再发破裂出血。结论根据3D—CTA检查，采取单侧翼点入路，针对视交叉位置及对侧动脉瘤的指向，一期显微夹闭BPcoAA是安全可行的。

One-stage operation for bilateral posterior communicating artery aneurysms via unilateral pterional approach: an efficacy analysis

Objective To investigate the feasibility and operative effect of the one-stage microsurgery for clipping of bilateral posterior communicating artery aneurysms （BpcoAA）. Methods The clinical data of 28 patients with BpcoAA were analyzed retrospectively. All patients underwent craniotomy and microsurgical clipping of BPcoAA via unilateral pterional approach. The patients were followed up for 6 months to 3 years after microsurgery. The head 3D-CTA of the patients and their general conditions were reexamined. The Glasgow outcome scale （GOS） scores were used to assess the prognosis. Results①Good preoperative 3D-CTA showed 28 cases with 56 aneurysms, the aneurysms were clipped completely in 24 cases, the contralateral aneurysms were not clipped completely in 3 cases, the aneurysm was not clipped completely on the approach side in 1 case, and none of the patients died. The aneurysms ruptured in 8 cases on the approach sides during the microsurgery. ②After microsurgery, 7 cases had hydrocephalus, and 5 had vasospasm on the approach sides and 3 on the contralateral sides, 3 suffered pulmonary infection, and 2 had oculomotor nerve injury on the contralateral sides. ③The mean follow-up time of the patients was 1.7 years. The GOS scores： 5 points in 10 cases, 4 points in 7 cases, 3 points in 9 cases, and 2 points in 2 cases. There were no aneurysm recurrence and new aneurysm formation. The patients whose aneurysms were not clipped completely had no recurrence of bleeding. Conclusion According to 3D-CTA examination, using unilateral pterional approach, aiming at the location of the optic chiasm and the contralateral aneurysm pointing, the one-stage microsurgery for clipping of BpcoAA is safe and feasible.