前交通动脉瘤显微手术技巧探讨

目的总结显微手术治疗破裂前交通动脉瘤的适应证、手术技巧要点及并发症的防治。方法回顾性分析应用显微手术治疗的36例破裂前交通动脉瘤患者的临床资料。结果本组36例中，33例行瘤颈夹闭满意，2例动脉瘤和前交通动脉一起被夹闭，1例行动脉瘤包裹术。出院时治疗结果好31例，差3例，死亡2例。所有患者术后随访3-36个月均无再出血发生。结论翼点入路手术治疗前交通动脉瘤暴露充分、术式成熟、并发症少；夹闭动脉瘤前充分分离、清晰暴露“H”形的前交通动脉复合体是手术成功的关键；合理的选择动脉瘤夹及血管穿通支的保护尤其重要。

Microsurgery for Aneurysms of Anterior Communicating Artery

Objectives To summarize the experience in treating the ruptured anterior communicating artery （AComA） aneurysms by microsurgery and explore the surgical indications, the technique points of the surgical procedure as well as the prevention and treatment of complications in the patients with ruptured AcomA aneurysms. Method The clinical data of 36 patients with ruptured AComA aneurysms treated by microsurgery were analyzed retrospectively. Results The aneurysms necks were successfully clipped in 33 patients, both the aneurismal necks and the AComA were clipped together in 2, and the aneurysms was wrapped in 1. According to GOS, the curative effects were good in 31 patients, poor in 3, and 2 died. No rebleeding occurred during a following up from 3 to 36 months in 34 survivors. Conclusions The microsurgery through pterional approach is an effective method to treat AComA aneurysms because it can make AComA aneurysms fully exposed and gives few complications. Adequate dissection and exposure of the entire H- shaped complex body of AcomA are the key to a successful clipping of aneurysms neck. The selection of aneurysm clip suitable for the aneurysm and the preservation of the perforating arteries should be specially emphasized.