多技术联合应用于颅内巨大动脉瘤的显微外科治疗

目的 探讨神经电生理监测、术中超声、术中荧光造影、神经内镜多技术联合应用于颅内巨大动脉瘤的显微外科手术治疗的临床效果。方法 回顾性分析显微手术治疗颅内巨大动脉瘤17例的临床资料。术前采用3D-CTA、MRI和DSA,充分评估动脉瘤的位置、大小和形状。术中应用神经电生理监测评价动脉瘤夹闭前、后的神经功能保留和损害程度；通过微血管多普勒超声的定性和定量分析联合术中荧光造影评定动脉瘤和周围邻近血管的血液流速及通畅度；神经内镜观察动脉瘤区的局部解剖，辨认重要的穿支血管、瘤颈结构和动脉瘤夹情况。手术在手术显微镜下操作，采用载瘤动脉控制性技术、瘤颈成形技术、动脉瘤内减压和切除技术、多瘤夹夹闭技术和血管痉挛保护技术等进行联合治疗。 结果 在多技术联合监测下，显微外科手术成功夹闭巨大动脉瘤17个，术后恢复良好15例，出现轻偏瘫1例，重度偏瘫l例，无死亡病例。DSA复查示瘤颈夹闭完全，载瘤动脉通畅。远期随访仍在进行中。 结论 多技术联合显微手术技术，能有效提高颅内巨大动脉瘤的手术疗效。

Application of multi-technology in intracranial giant aneurysm microsurgery

Objective To discuss the application of neurophysiological monitoring (NEPM), intraoperative color Doppler ultrasonography, fluorescein angiography and neuroendoscope in clinical effects of intracranial giant aneurysm microsurgey. Methods To retrospectively review the clinical data of 17 intracranial giant aneurysm. Pre-operative imaging were used, including 3D- CTA, MRI and DSA, to make dectection and delineation of the aneurysm. The NEPM to evaluate the nerve function, assess the qualitative and quantitative flow rate of aneurysm and surrounding blood vessels by Doppler ultrasonography and fluorescein angiography, and reveal opography of aneurysm, protect the considerable perf.vessels and nerves by neuroendoscope. Operative techniques were used including parent artery control, aneurysm neck forming, aneurysm decompression and resection, obliteration of aneurysm with multiple clips and vasospasm protection.Results Seventeen cases of giant aneurysms were clipped successfully under muti-technology, follow-up demonstrated excellent neurological outcomes in 15 cases, one case had mild disability, one case had severe disability, no dead cases. DSA showed clipping completely, parent artery clear, and long-term follow-up was still in progress. Conclusion Multi-technology combined microsurgical techniques which can effective improve the outcomes of intracranial giant aneurysms.