大脑中动脉动脉瘤的显微手术治疗

目的总结显微外科手术处理大脑中动脉动脉瘤的经验。方法1998年1月～2006年1月共手术治疗大脑中动脉动脉瘤36例，男19例，女17例。年龄12～65岁（平均41岁）。36例共计38个大脑中动脉动脉瘤，动脉瘤大小3～60mm，其中3～7mm9个，8～14mm17个，15～24mm7个，≥25mm5个。术前破裂出血30例，其中14例形成脑内血肿；6例因其它疾病或体检时偶然发现。所有病例经DSA检查，部分病人同时行MRA或CTA检查，其中2例病人DSA检查未发现动脉瘤，而CTA则清楚显示动脉瘤。4例病人合并有其它部位动脉瘤，2例为双侧镜影动脉瘤。动脉瘤位于大脑中动脉分叉部30个，分叉部近端7个、远端1个。采用翼点入路，显微镜下打开侧裂，依动脉瘤部位，逆行或顺行沿大脑中动脉主干（支）寻找分离动脉瘤，并夹闭之。结果全部38个动脉瘤均用一个或多个动脉瘤夹夹闭，其中8个大或巨大动脉瘤同时摘除血栓并切除大部瘤体以解除其占位效应。术后恢复良好28例，发生偏瘫失语7例（因局部脑梗塞所致），死亡1例。结论显微手术治疗大脑中动脉动脉瘤可以获得满意疗效，术中应尽量避免损伤大脑中动脉的分支，防止术后发生脑梗塞造成患者神经功能障碍。

Microsurgery management of middle cerebral artery aneurysms

Objective To investigate the microsurgery management of middle cerebral artery aneurysms(MCAAs).Methods From January 1998 to January 2006,a total of 36 cases of MCAAs performed surgical management,including 19 male patients and 17 female patients ranged from 12 to 65 years old(mean age of 41 years old).In these 36 cases,38 middle cerebral artery aneurysms were found.The size of aneurysms varied from 3 to 60 mm,with 3~7 mm in 9 aneurysms,8~14 mm in 17 aneurysms,15~24 mm in 7 aneurysms and larger than 25 mm in 5 aneurysms.Pre-operative rupture and hemorrhage appeared in 30 cases,with 14 cases incurring intracranial hematoma;6 cases were found because of other disease or physical examination.All the patients performed DSA and a part of patients undertook MRA or CTA in the same time,but 2 patients did not find aneurysm by DSA while CTA showed clearly the presentation of aneurysm.Four patients accompanied with aneurysms in other places,2 cases presented mirror MCAAs.Thirty aneurysms located in the bifurcation of middle cerebral artery,7 aneurysms located in proximal and 1 in distal part of bifurcation.The lateral fissure was incised under microscope via pterional approach.According to the location of aneurysms,thrashed or went directly along the middle cerebral artery aneurysm stem to search and isolate aneurysm and clipped it.Results Thirty-eight aneurysms were clipped with one or several aneurismal clips,while 8 cases of large or giant aneurysms were dissected large part of aneurysm body and thrombus simultaneously to resolve the space occupying signs.Good recovery obtained in 28 cases,hemiparalysis and aphasia presented in 7 patients(incurred by local cerebral infarction),and 1 case of death.Conclusion Microsurgery treatment of middle cerebral artery aneurysms may get satisfactory effects.The operation should avoid damaging the branches of middle cerebral artery and prevent the dysneuris in patients incurred by post-operative cerebral infarction.