摘要
目的探讨后交通动脉瘤影像学特点以及显微外科手术夹闭技巧。方法纳入行开颅手术夹闭治疗的后交通动脉瘤患者48例(共51个动脉瘤),回顾性分析患者的影像学资料、手术视频资料,分析瘤体直径、瘤颈直径、手术入路、术中脑脊液引流方法、是否行临时阻断及阻断方法、瘤夹选择、夹闭技巧等,总结后交通动脉瘤影像学特点对手术操作的指导作用以及术中处理的技巧。结果2组动脉瘤瘤体直径、瘤颈直径以及瘤体-瘤颈比比较,差异无统计学意义(P>0.05)。51个后交通动脉瘤中,32个(63%)合并胚胎型大脑后动脉;41个(80%)采用小翼点入路夹闭;36个(71%)破裂动脉瘤采用术前腰大池置管引流;42个(82%)动脉瘤采用单纯近端阻断。34个指向后下外侧的后交通动脉瘤中,27个(79%)采用直动脉瘤夹夹闭;15个指向后下内侧的动脉瘤中,13个(87%)选用弯动脉瘤夹夹闭。46个(90%)动脉瘤行瘤颈完全夹闭。术后3个月,42例(87%)患者预后良好(GOS为4~5分)。结论破裂动脉瘤术中控制脑压至关重要,可采取腰大池置管、视交叉池开放、脑室穿刺、终板开放等方法引流,分离动脉瘤前行临时阻断安全有效;术前影像显示动脉瘤顶指向对动脉瘤夹的选择具有指导意义,识别并保留所有血管神经结构是取得理想治疗效果的关键。
Objective To investigate the radiographic features and microneurosurgical clipping technique of posterior communicating artery aneurysms.Methods A total of 48 patients with posterior communication aneurysms(51 aneurysms in total)who underwent craniotomy cliping were included,and the imaging data and surgical video data of the patients were retrospectively analyzed.The tumor diameter,tumor neck diameter,surgical approach,intraoperative cerebrospinal fluid drainage method,temporary clipping and clipping method,selection of aneurysm clip,clipping technique were analyzed,so as to summarize the role of imaging characteristics of posterior communicating aneurysm in guiding surgical operation and intraoperative management skills.Results There was no statistically significant difference between the two groups in tumor diameter,tumor neck diameter and tumor body-tumor neck ratio(P>0.05).Of the 51 posterior communicating artery aneurysms,32(63%)were complicated with fetal posterior cerebral artery;41(80%)were clipped with mini-pterional approach;36(71%)ruptured aneurysms were treated with preoperative lumbar cisterna drainage;42(82%)aneurysms were simply proximal occluded.Of the 34 posterior communicating aneurysms projecting postero-laterally,27(79%)were clipped with straight aneurysm clips.Of the 15 posterior communicating aneurysms pointing postero-medially,13(87%)were clipped with curved aneurysms clips.Totally 46(90%)aneurysms were completely clipped on the aneurysmal neck.Three months after the operation,42 patients(87%)had a good prognosis(GOS score was 4 to 5 points).Conclusion It is of great importance to control cerebral pressure during ruptured aneurysms surgery.Lumbar drainage,chiasmatic cistern,ventricular puncture and lamia terminalis fenestration can be adopted to achieve drainage.Temporary clipping is safe and effective to avoid premature rupture.Preoperative imaging showed that aneurysmal apex orientation is of guiding significance for the selection of aneurysm clips,and the identification and preservation of all the vascular and nerve structures is the key to achieve the ideal therapeutic effect.
作者
谢满意
王强
聂耳
李中林
XIE Man-yi;WANG Qiang;NIE Er;LI Zhong-lin(Department of Neurosurgery,Affiliated Hospital of Xuzhou Medical University,Xuzhou Jiangsu 221000,China)
出处
《局解手术学杂志》
2020年第12期971-975,共5页
Journal of Regional Anatomy and Operative Surgery
基金
国家自然科学基金青年项目(81802490)。
关键词
外科治疗
手术夹闭
影像学
后交通动脉瘤
手术技巧
脑室穿刺
腰大池置管
microneurosurgical treatment
clipping
radiography
posterior communicating artery aneurysm
surgical skills
ventricular puncture
lumbar cisterna drainage
