锁孔微创入路手术治疗颅内动脉瘤的风险因素及对策分析

目的 探讨颅内动脉瘤在锁孔手术中破裂的风险因素、适应证选择、手术难点、预防动脉瘤破裂的方法及应急处理措施.方法 回顾性分析1999年至2005年115例动脉瘤患者的临床资料.将动脉瘤破裂风险较低的43例患者通过锁孔微创入路手术治疗（锁孔组）,其余72例患者采用常规开颅手术治疗（常规组）.锁孔组43例患者手术中翼点锁孔入路20例,眶上锁孔入路18例,纵裂锁孔入路5例.常规组72例患者风险高而采用常规翼点开颅31例,额下开颅11例,纵裂开颅7例,翼点-额下联合10例,翼点-纵裂联合6例,额下-纵裂联合4例,翼点-额下-纵裂联合3例.结果 锁孔组术中动脉瘤渗漏6例,破裂出血3例,发生率为7%,无手术死亡.2例在锁孔手术中无法夹闭动脉瘤而改为常规开颅.常规组术中发生动脉瘤渗漏18例,破裂出血9例,发生率为13%,手术后死亡2例.结论 尽管锁孔手术有微创、伤口美观、术后恢复快等优点,但在风险低的患者中动脉瘤渗漏和破裂的风险仍然不能忽视.

The risk factors and preventions in keyhole minimally invasive approaches of intracranial aneurysms

Objective To evaluate the risk factors and study the methods of prevention and treatment for the ruptures of aneurysms in keyhole minimally invasive approaches.Methods From 1999 to 2005,115 cases of intracranial aneurysms were divided into 2 classes according to the risk factors of aneurysm rupture.Forty-three cases of lower risk underwent microsurgical procedures as keyhole approaches,including pterional approach in 20 cases,supraorbital approach in 18 cases,interhemispheric approach in 5 cases.Seventy-two cases,rest of microsurgical procedures,were performed as conventional craniotomy,including pterional approach in 31 cases,supraorbital approach in 11 cases,interhemispheric approach in 7 cases,pterional-supraorbital in 10 cases,pterional- interhemispheric in 6 cases,supraorbital- interhemispheric in 4 cases,pterional-supraorbital-interhemispheric in 3 cases.Results Six aneurysms leaked and 3 ruptured(rupture rate 7.0%)treated with keyhole approaches during operations.No one died by keyhole approaches.Eighteen aneurysms leaked and 9 ruptured(rupture rate 12.5%)treated with conventional approaches during operations.Two patients died by conventional approaches.Conclusions Keyhole approaches as a time-saving,trauma-reducing procedure could improve the postoperative outcomes, but these approaches still exist probability of aneurysm rupture.It is possible that keyhole-bone flap becomes a limitation to deal with huge or ruptured aneurysms.And it is important to make a specially preventive strategy for aneurysm rupture.