手术治疗颅内双侧多发动脉瘤

目的探讨颅内双侧多发动脉瘤的手术方法及其疗效。方法回顾性分析2009年10月至2014年9月手术治疗的60例颅内双侧多发性动脉瘤临床资料,其中采用单侧扩大翼点入路一期手术治疗34例;双侧翼点入路一期或分期手术治疗26例,分期手术治疗时间间隔为15 d~4年。结果单侧入路手术病人术后发生颅内感染1例、低钠血症1例、脑积水2例、脑血管痉挛1例;双侧入路手术病人术后发生颅内感染2例、低钠血症1例。术后随访3~24个月,单侧扩大翼点入路一期手术治疗的34例中,GOS评分5分14例,4分18例,3分2例。双侧翼点入路手术治疗的26例中,GOS评分5分10例,4分14例,3分2例。DSA复查均未发现动脉瘤复发。结论单侧及双侧扩大翼点入路夹闭治疗颅内双侧多发动脉瘤的效果均较好,但适用范围存在一定局限性,需根据病人具体病情状况,对手术方式进行合理选择。

Microsurgery for bilateral multiple intracranial aneurysms

Objective To observe the curative effects of microsurgery on bilateral multiple intracranial aneurysms. Methods The clinical data of 60 patients with bilateral multiple intracranial aneurysms, of whom, 34 were treated by one-stage microsurgery through unilateral extended pterional approach and 26 by one-stage or staging microsurgery through bilateral extended pterional approach from October, 2009 to September, 2014, were analyzed retrospectively. All the intracranial aneurysms were definitely diagnosed by DSA or CTA before the operation. All the patients were followed up from 3 to 24 months. Results The postoperative complications in 34 patients undergoing unilateral craniotomy included intracranial infection in 1 patient, hyponatremia in 1, hydrocephalus in 2 and vascular spasm in 1. The postoperative complications in 26 patients undergoing bilateral craniotomy included intracranial infection in 2 patients and hyponatremia in 1. The following up of 34 patients undergoing unilateral craniotomy showed that GOS scores were 5 points in 14 patients, 4 in 18 and 3 in 2. The following up of 26 patients undergoing bilateral craniotomy showed that GOS scores were 5 pints in 10 patients, 4 in 14 and 3 in 2. The intracranial aneurysms did not recur in all the patients during the following-up. Conclusions The microsurgery through unilateral or bilateral extended pterional approach reasonably chosen according to the intracranial aneurysms characteristics including the aneurysmal location, shape, direction and so on is very helpful to the increase in the curative effects and decrease in the postoperative complication and aneurysmal relapse.