摘要
目的探讨经硬膜外-内联合入路治疗床突旁动脉瘤的手术技巧及效果。方法回顾性分析16例床突旁动脉瘤病人的临床资料,其中多发动脉瘤2例,共检出动脉瘤19个。采用硬膜外-内联合入路夹闭瘤颈,术中监测运动和体感诱发电位,并采用术中超声检测动脉血流。结果成功夹闭动脉瘤18个,1个病变对侧大脑中动脉瘤予以观察。术后并发颅内感染1例,脑积水4例,动眼神经麻痹6例。头痛和眼眶疼痛病人术后疼痛均明显缓解,1例术前突发头痛伴昏迷病人术后仍昏迷;2例视力下降、视野缺损病人术后改善1例,无明显变化1例。术后6个月GOS评分:恢复良好或轻度残疾14例,重度残疾1例,植物生存1例。结论经硬膜外-内联合入路有利于早期控制载瘤动脉,可获得良好的术野暴露,是显微手术治疗床突旁动脉瘤安全、有效的方法。
Objective To explore the surgical skills and therapeutic effect of epidural combined with subdural approach for paraclinoid aneurysms.Methods Clinical data of 16 patients with paraclinoid aneurysms were analyzed retrospectively,including multiple aneurysms in 2 patients,and 19 aneurysms were found in 16 patients.Clipping the neck of the aneurysm was performed in all the patients via epidural combined with subdural approach,and electrophysiological examination and ultrasonography were used in surgery.Results Eighteen aneurysms were successfully clipped,and 1 contralateral middle cerebral artery aneurysms was observed.Intracranial infection occurred in 1 patient,hydrocephalus in 3 patients and oculomotor nerve palsy in 6 after the operation.The headache and orbital pain were improved obviously after the operation.One patient with sudden headache and coma before the operation was still in a coma after the operation.Two patients with decreased visual acuity and visual field defect was improved in 1 and not changed in 1.Fourteen patients had good recovery or moderate disability,1 suffered severe disability and 1 was in persistent vegetative state by GOS 6 months after the operation.Conclusions Epidural combined with subdural approach is favorable for early control of parent artery and exposing aneurysms,it is a safe and efficient approach for paraclinoid aneurysms.
出处
《中国微侵袭神经外科杂志》
CAS
2017年第12期551-553,共3页
Chinese Journal of Minimally Invasive Neurosurgery
关键词
颅内动脉瘤
手术入路
经硬膜外-内
前床突
显微外科手术
intracranial aneurysm
surgical approach, epidural combined with subdural
anterior clinoid process
microsurgery
