单侧翼点入路一期手术治疗颅内多发性动脉瘤

目的探讨经单侧翼点入路一期手术治疗颅内多发性动脉瘤(MIA)的术前评估和手术要点。方法回顾性分析2008年2月至2009年7月采用单侧翼点入路一期手术治疗的21例MIA患者的临床资料。入院时患者病情按Hunt-Hess分级:Ⅰ级7例,Ⅱ级9例,Ⅲ级5例。术前充分评估,术中优先处理责任动脉瘤,并遵循由浅入深、先易后难的顺序进行手术;若动脉瘤位于双侧,夹闭本侧动脉瘤后,继续分离视交叉区域及对侧各间隙直至显露瘤颈及载瘤动脉的近端和远端。结果 21例共45个动脉瘤,直接夹闭36个,单纯包裹5个,电凝烧灼加包裹4个。平均术后随访约10个月,其中治愈或良好17例,轻残2例,重残1例,植物生存1例,无死亡病例。结论经充分的术前评估,单侧翼点入路一期手术治疗MIA是可靠、有效的方法之一。

Treatment of multiple intracranial aneurysms by one-stage microsurgery through unilateral pterional approach

Objective To explore the preoperative assessments of multiple intracranial aneurysms（MIA）and microsurgicalt echnique to treat them.Methods The clinical data of 21 patients with 45 aneurysms,who underwent one-stage microsurgery throughu nilateral pterional approach from February,2008 to July,2009,were analyzed retrospectively.According to Hunt-Hess grading,thed isease condition belonged under gradeⅠin 7 patients,gradeⅡin 9 and gradeⅢin 5.The full preoperative assessments includingt he aneurysms responsible for subarachnoid hemorrhage（SAH）,the probability of clipping the bilateral aneurysms by one-stagem icrosurgery through unilateral pterional approach and so on.Results Of 45 aneurysms in 21 patients,36 were successfully clipped,5w rapped,and 4 coagulated and wrapped.Following up for 10 months showed that of 21 patients,17 were recovered well,2 mildlyd isabled,1 seriously disabled and 1 survived vegetatively.Conclusion The treatment of MIA by one-stage microsurgery throughu nilateral pterional approach is safe and feasible after the full preoperative assessment is made in the patients with MIA.