前循环动脉瘤的诊断和显微手术治疗

目的:探讨前循环动脉瘤的诊断方法、手术时机和显微外科手术技巧。方法:回顾性分析12例前循环动脉瘤的检查方法、影像学特征、诊治过程及手术效果。结果:12例患者均行头颅CT检查,均显示蛛网膜下腔出血(SAH);9例行CT血管造影(CTA)检查;11例行数字减影全脑血管造影(DSA)。12例患者均采用翼点入路、气管插管全麻下行动脉瘤瘤颈夹闭术,术中瘤体破裂出血7例。出院时按GOS评分:恢复良好者9例;2例中度病残,但生活能自理;1例重度病残者生活不能自理。随访3～12个月,全组均无再出血发生、无死亡。结论:动脉瘤的确诊主要依靠DSA检查,但其阴性者应结合CTA综合判断,一经确诊尽早手术。目前,显微镜下选择翼点入路手术夹闭瘤颈仍是前循环动脉瘤的首选方法。

Diagnosis and microsurgical treatment of anterior circulation aneurysm

Objective：To explore the diagnostic methods,operation timing and microsurgical approach to the treatment of anterior circulation aneurysm. Methods：The clinical data of 12 patients were reviewed concerning the examination,imaging characteristics,diagnostic procedure and surgical outcomes. Results：Skull CT examination showed that the total 12 patients complicated with subarachnoid hemorrhage. Of the 12 cases,9 received additional CT angiography（CTA） and 11,digital subtraction angiography（DSA）. Under general anesthesia through endotracheal intubation,all patients were undergone the operation by clipping of aneurysm via pterional approach,but intraoperative hemorrhage was found in 7 patients due to ruptured aneurysm. Evaluation of the therapeutic at discharge by GOS score suggested that 9 recovered well,2 suffered from moderate disability,but with self-care ability,and 1,severe disability and lost self-care. The follow-up lasted from 3 to 12 months and showed no occurrence of re-bleeding of aneurysm and death. Conclusion：Final diagnosis of aneurysm relies on DSA,but CTA is recommended for further examination in angiographically normal cases. Once finally diagnosed,early surgery is necessary. However,microscopic clipping of aneurysm via pterional approach remains the preferable procedure in treatment of anterior circulation aneurysm.