经翼点入路前交通动脉瘤的显微手术治疗(附398例报告)

目的 总结经翼点入路显微手术夹闭前交通动脉痛的优缺点.方法 对398例前交通动脉瘤采用经翼点入路直接夹闭术的结果 进行回顾性分析.由于舣侧A1段常发育异常及相应的前交通动脉的血流方向的个体差异,动脉瘤的形态变化及生长方向不同,手术入路的定侧与难度亦有所不同.结果 本组病例中6例(Hunt-HessⅣ级2例, Ⅴ级4例)由于严重脑血管痉挛等并发症,分别于术后3 d至3周内死亡.随诊时间为3个月至22年不等,短期内全组病人均获得随诊,但长期随诊者为295例,97例失访.随访的病人中Ⅰ、Ⅱ级214例(72%)均恢复正常工作,Ⅲ级者42例(14%)恢复正常工作,23例(7.7%)生活自理,3例(1%)不能生活自理.Ⅳ级者中有4例(1.3%)恢复正常工作;Ⅴ级中有1例恢复正常工作,1例不能生活自理.结论 经翼点人路直接显微手术,是治疗前交通动脉瘤较为理想的方法.手术前仔细阅片,了解前交通动脉区的血管关系及血流变化,对于手术入路选择至关重要.

Microsurgical clipping by pterional approach for an anterior communicating artery aneurysm

Objective To analyse, the advantages of the pterional approach to an anterior communicating artery aneurysm. Method 398 cases of an anterior communicating aneurysm were clipping treated by the pterional approach, The site of an aneurysmal neck and the direction of growing projection mustbe classified accurately from the preoperative angiography. Results 6 of eases died of serious vasospasm; During 3months-22years,295 cases were followed up,all of cases with Hunt-hess 1 and 2 were good(72%), 42 of cases with 3 recovered(14%) ,4 of cases with 4 returned to normal(1.3%) ,one case recovered and one disabled in the group with 5. Conclusions Although a pterionai approach to an anterior communicating artery anrurysm is an excellent accessing method,it should be emphasized the preoperative evaluation the aneurysmal neck, position, direction, relation of vaseulars around anterior communicating artery aneurysm and anomalies.