脉络膜前动脉起始处动脉瘤的显微手术治疗

目的总结脉络膜前动脉（AChA）起始处动脉瘤的诊断、手术治疗技巧、脑缺血等并发症防治。方法以2007年8月—2013年8月我科经显微手术治疗的ll例脉络膜前动脉起始处动脉瘤患者临床资料为研究对象，对术前诊断、手术技巧、术后脑缺血并发症防治做回顾性分析。结果11例脉络膜前动脉瘤术前诊断正确8例，3例误诊为后交通动脉瘤。所有动脉瘤均顺利手术夹闭。术后出现脉络膜前动脉供血区梗塞2例。GOS评分：恢复良好9例，中度残疾1例，重度残疾1例。术后随访3～24个月，无再出血病例。结论术中清晰显露瘤颈与周边血管关系，正确辨认、保护脉络膜前动脉对安全夹闭动脉瘤、预防术后脑缺血性并发症至关重要。

Microsurgical clipping of aneurysm located at the proximal anterior choroidal artery

Objective To summarize the diagnostic and surgical skills involved in the treatment of aneurysm located at the proximal anterior choroidal artery （AChA） and how to prevent postoperative ischemic complication. Methods Eleven patients with aneurysm located at the proximal anterior choroidal artery were included who were admitted to our hospital from August 2007 to August 2013 and underwent microsurgical clipping. Then, preoperative diagnosis, surgical skills and preventive methods to avoid postoperative ischemic events were reviewed retrospectively. Results Among the eleven cases, eight were correctly diagnosed, while the other three were misdiaguosed as posterior communicating artery aneurysm before surgery. All the AChA aneurysms were clipped and two patients manifested infarction in the blood supplying area of AChA. For GOS scores, nine cases had good recovery, one patient presented moderate disability, and one patient was reported severe disability. No bleeding case was reported during 3 - 24 months of follow - up visits. Conclusion It is of importance to recognize aneurysm and identify its relationship with surrounding vessels for microsurgical clipping and better prevention of postoperative ischemic events.