摘要
目的探讨经翼点入路手术夹闭前交通动脉动脉瘤的显微手术技巧。方法回顾性分析78例前交通动脉动脉瘤病人的临床资料。超早期手术64例,早期手术9例,延期手术5例。结果 58例术前Hunt-Hess分级Ⅰ～Ⅲ级病人出院时GOS4～5分50例,3分5例,2分1例,1分2例;20例Hunt-HessⅣ～Ⅴ级病人出院时GOS4～5分15例,3分2例,2分2例,1分1例。对62例患者随访6～12个月,无再出血,无死亡。结论早期手术夹闭前交通动脉动脉瘤能防止动脉瘤再次破裂;对于Hunt-HessⅣ～Ⅴ级病人,在条件许可下行早期手术,仍可取得一定疗效;术中清除脑池内积血能减轻脑血管痉挛,改善患者预后。
Objective To investigate the skill of microsurgery through the pterional approach for the anterior communicating artery （ACoA） aneurysms. Methods The clinical data of 78 patients with ACoA aneurysms were analyzed retrospectively. Of 78 patients with ACoA aneurysms, 64 underwent microsurgery within 24 hours after the aneurysmal rupture, 9 from 24 to 72 hours and 5 more than 72 hours. Results Of 58 patients with preoperative Hunt-Hess grades [ ~ Ill, 50 were recovered well （GOS 4-5 scores）, 5 severely disabled （GOS 3 scores）, 1 survived vegetatively （GOS 2 scores） and 2 died. Of 20 patients with preoperative Hunt-Hess grades IV- V, 15 were recovered well, 2 severely disabled, 2 SUlvived vegetatively and 1 died. Bleeding did not recurred and no patients died in 62 patients followed up from 6~12 months. Conclusions The reruptures of ACoA aneurysms may be prevented by mierosurgery early after the aneurismal rupture, which may be performed also in the patients with Hunt-Hess grades IV - V in whom the disease conditions permitted. Intraoperative clearance of the subaraehnoid and intracisterual hemorrhage can reduce cerebral vasospasm and improve the prognosis in the patients with ACoA aneurysms.
出处
《中国临床神经外科杂志》
2012年第12期725-726,729,共3页
Chinese Journal of Clinical Neurosurgery
关键词
前交通动脉
颅内动脉瘤
显微外科手术
翼点入路
蛛网膜下腔出血
Anterior communicating artery
Intracranial aneurysm
Microsurgeby
Pterional approach
Subarachnoid hemorrhage
