显微外科治疗47例大脑中动脉分叉部动脉瘤

目的探讨大脑中动脉分叉部动脉瘤显微外科手术技巧。方法回顾性分析10年47例显微外科治疗的大脑中动脉分叉部动脉瘤临床特征。37例以蛛网膜下隙出血起病,其中20例伴颅内血肿;Hunt-Hess分级Ⅰ级3例,Ⅱ级6例,Ⅲ级17例,Ⅳ级8例,Ⅴ级3例;动脉瘤平均直径9.3mm;指向前上型17例,后向型22例,下向型8例。结果采用格拉斯哥预后评分对患者进行0.5～4年随访。良好16例,中残18例,重残6例,植物状态2例。术后死亡5例,2例死于大面积脑梗死。结论大脑中动脉分叉部动脉瘤常见巨大复杂形态以及合并颅内血肿。早期手术干预能有效改善患者预后。合理的手术入路,对M1、M2穿支的辨认,适时的临时阻断以及良好的夹闭习惯是手术操作的关键。

Microsurgical treatment of 47 patients with middle cerebral artery bifurcation aneurysms

Objective To explore microsurgical skill of middle cerebral artery bifurcation aneurysms.Methods Retrospectively reviewing of clinical situation of 47 patients with middle cerebral artery bifurcation aneurysms that were treated microsurgically.37 had subarachnoid hemorrhages,20 of whom had additional intracerebral hematoma.There were 3 in Hunt and Hess Grade,6 Grade,17 Grade,8 Grade,and 3 Grade.The average diameter of the aneurysms was 9.3 mm.According to the projection of the dome,17 were anterosuperior projection,22 were posterior projection,and 8 were inferior projection.Results The Glasgow Outcome Scale was used to evaluate the feedback of patients in 0.5～4 years.Among all the patients,16 had good recovery,18 moderate and 6 severe disability and 2 in vegetative state.5 patients died after surgery and 2 of them got a large area cerebral infarction.Conclusion Middle cerebral artery bifurcation aneurysms are often big and complicated,dysmorphic in shape and harboring intracranial hematoma.Early surgical treatment could effectively improve patient prognosis.Reasonable surgical approach,precisely identification of M1 or M2 perforators,right time temporary clipping and good clipping practice are the keys to the success operation.