摘要
目的探讨显微外科治疗前交通动脉动脉瘤的手术入路、术中监测和术后并发症。方法回顾性分析2003年1月至2011年12月手术治疗430例前交通动脉动脉瘤患者的临床资料,结合术前的影像学资料和前交通动脉动脉瘤的解剖学特点,采用翼点入路手术治疗370例,大脑纵裂入路12例,眶上外侧入路48例。结果术后行DSA或CT脑血管造影检查证实前交通动脉动脉瘤均夹闭完全。出院时按GOS评估预后,430例患者中,恢复良好者330例,中残58例,重残25例,死亡17例。结论结合术前的影像学资料和前交通动脉动脉瘤的解剖学特点,采用合理的手术入路进行手术,以及术中采用微血管多普勒超声监测对保证手术安全性和提高手术成功率至关重要;终板造瘘可以降低动脉瘤术后脑积水的发生率;熟练掌握显微外科手术技巧以及术后及时处理,可以降低术后并发症的发生率。
Objective To explore the approaches and technique, and postoperative complications of microsurgery for anterior communicating artery （ACoA） aneurysms. Methods The clinical data of 430 patients with ACoA aneurysms, of whom, 370 underwent microsurgery through the pterional approach, 12 through the cerebral longitudinal fissure approach and 48 the through the lateral susupraorbital approach from January, 2003 to December, 2011, were analyzed retrospectively. Results All the ACoA aneurysms were preoperatively diagnosed as by the CT angiography or DSA examination. Of 430 patients with ACoA aneurysms, 330 were recovered well, 58 moderately disabled, 25 severely disabled and 17 died on discharge from hospital. Conclusions The reasonable microsurgical approaches should he used according to the preoperative imaging data and anatomic characteristics of ACoA aneurysms. The incidence of hydrocephalus may he reduced by the fenestration of the lamina terminalis in the patients with intraventricular collected blood due to aneurismal rupture. The skilful microsurgieal technique is helpful to reducing the postoperative complications in the patients with ACoA aneurysms.
出处
《中国临床神经外科杂志》
2012年第12期707-709,共3页
Chinese Journal of Clinical Neurosurgery
基金
江苏省医学重点学科基金项目(NO:xk2007227)
关键词
前交通动脉
颅内动脉瘤
显微外科手术
术后并发症
Anterior communicating artery
Aneurysm
Microsurgery
Postoperative complication
