锁孔择期手术治疗破裂的大脑中动脉瘤32例

目的探讨锁孔神经外科手术治疗后交通动脉瘤的手术技巧和适应证。方法回顾性分析32例破裂的大脑中动脉瘤病例,全部经DSA或CTA确诊,出血2周后行眉弓上锁孔开颅,显微神经外科手术动脉瘤夹闭。结果 32例全部夹闭,无1例死亡,治愈率100%。术后1周内头部CTA,动脉瘤消失,载瘤动脉通畅,动脉瘤夹固定良好。10例于术后3～6个月进行了随访（CTA或DSA）,未见复发。结论锁孔手术是治疗大脑中动脉瘤的微创治疗技术,减少了手术创伤及并发症,恰当地选择适应证和手术时机及应用显微外科技术是治疗的关键。

Selective operation of keyhole approach for middle cerebral artery aneurysm in 32 cases

Objective To analyze the indications and operation skills of neurologic surgical keyhole approach in treatment of posterior communicating artery aneurysm.Methods A retrospective analysis had been made in 32 cases of ruptured middle cerebral artery aneurysm（MCA）.All cases had been diagnosed by distal subtraction angiography（DSA） or computed tomography angiography（CTA）.The ruptured aneurysms were all treated with microsurgery by keyhole approach two weeks after bleeding.Results The ruptured aneurysms were clipped successfully in 32 cases,the curative rate reaching 100% with no case died.The artery clipper was fixed well,the aneurysm was disappeared and supply artery was maintained smoothly.No recurrence was found in the follow-up（CTA or DSA） of 3～6 months in 10 cases.Conclusion The keyhole surgery is a technique of minimally invasive in treating MCA.It is helpful to reduce the mortality and morbidity.Applying microsurgery technique in the right timing is the key point of the treatment.