摘要
目的探讨前交通动脉瘤的解剖学特点、手术时机、手术中注意事项以及并发症的预防。方法采用显微外科手术治疗前交通动脉瘤70例(73个),手术入路以优势供血侧翼点入路为主。共夹闭动脉瘤65个,包裹7个,大部分切除并夹闭1个。62例术中采用了血管临时阻断技术。对于大型或瘤体复杂指向的前交通动脉瘤,术中进行脑电图和体感诱发电位监测。8例同时行终板造瘘。结果本组70例中,56例术后行DSA检查,绝大多数动脉瘤夹闭满意。出院时治疗结果好62例,差6例,死亡2例。结论对于急性期前交通动脉瘤,Hunt-HessⅠ-Ⅱ级的病例应尽早手术,Ⅲ级的病例应争取在出血后3d内手术,Ⅳ-Ⅴ级的病例应在血管造影的同时用弹簧圈栓塞,若条件不允许,则应先给予合理的内科治疗,等病情稳定后再考虑手术。优势供血侧翼点入路有利于临时阻断血管,降低动脉瘤未成熟破裂的风险。术中脑电图和体感诱发电位监测可以早期发现脑缺血,防止发生偏瘫。
Objective To explore the clinical features of anterior communicating artery （AComA） aneurysms, time and the main points of the microsurgery for the aneurysms, and the prevention of postoperative complications. Methods Most of 70 patients with 73 aneurysms underwent microsurgery through pterional approach on the dominant side of blood supply for the anerurysms. Of 73 aneurysms, 65 were clipped, 7 were wrapped, and 1 was resected in great part after clipping. Temporary occlusion of the parental arteries was performed in 62 patients. Intraoperative EEG and sensory evoked potential monitoring were performed in patients with large or complicated AComA aneurysms. Fenestration of the lamina terminalis was done in 8 cases. Results Postoperative DSA in 56 cases showed that most of aneurysms were chpped satisfactorily. According to GOS, the early curative effects were good in 62 cases, poor in 6 cases and 2 died. Conclusions The operation should be done as early as possible in the patients with grade Ⅰ-Ⅱ of Hunt and Hess. The operation should be performed within 3 days after the nearest rupture in patients with grade Ⅲ. Grade Ⅳor Ⅴpatients should be treated by a rational conservative therapy. Pterional approach on the dominant side of blood supply for the aneurysms was helpful to temporary occlusion of parent artery. Temporary occlusion of segments 1 of the bilateral anterior cerebral arteries can reduce the risk of aneurysm rupture during the operation. Intraoperative EEG and sensory evoked potential monitoring can detect the cerebral ischemia in the early stage, and is helpful to the judgment of unexpected occlusion of the anterior cerebral artery or its branches.
出处
《中国临床神经外科杂志》
2007年第12期705-707,共3页
Chinese Journal of Clinical Neurosurgery
关键词
前交通动脉瘤
手术
血管临时阻断
电生理监测
Anterior communicating artery
Aneurysms
Surgery
Temporary vascular occlusion
Electrophysiological monitoring
