385例前交通动脉瘤显微手术治疗疗效分析

目的探讨前交通动脉瘤的术前诊断、手术时机及手术技巧对术后疗效的影响。方法回顾性分析作者自1997年1月至2012年6月行显微外科手术治疗前交通动脉瘤385例患者的临床表现、影像资料、手术治疗及预后情况。结果 385例患者中,Hunt-Hess 0级5例(未破裂),Ⅰ级7例,Ⅱ级177例,Ⅲ级148例,Ⅳ级39例,Ⅴ级9例;采用翼点入路383例,2例采用冠状切口入路;早期(3 d)手术238例,中期(3 d~2 w)手术118例,晚期(2 w)29例。治愈340例(88.3%)、好转13例(3.4%)、植物生存6例(1.6%)、死亡26例(6.8%)。结论经翼点入路显微外科手术治疗前交通动脉瘤,术中暴露清楚,夹闭瘤颈可靠,术后并发症少,是一种有效的方法。选择最佳手术时机,熟练掌握显微操作技术及显微解剖知识是手术成功的关键。

Microsurgical treatment of anterior communicating artery aneurysms： analysis of 385 cases

Objective The effect of diagnosis, operation time and operation skills on the prognosis of anterior communicating aneurysms （ACoA） are studied. Methods A retrospective study was made on a total of 385 eases of anterior communicating aneurysms in our hospital from January of 1997 to June of 2012, including the clinical manifestations, imaging findings, operation treatment and prognosis. Results Among those 385 patients, there were 5 cases of Hunt-Hess grade 0, 7 cases of grade I, 177 cases of grade II, 148 cases of grade III, 39 cases of grade IV, and 9 cases of grade V; 383 cases were operated via pterion approach and 2 cases via the coronary incision. Early-stage operation was performed in 238 while middle and late stage operation were performed in 118 and 29 eases, respectively. There were 340 cases of recovery, 13 cases of improvement, 6 cases of vegetative state and 26 cases of death. Conclusion The mierosurgical operation via pterion approach has been featured by a distinct exposure of the aneurysm, a reliable clip occlusion and a low rate of complication, which means that it can be seen as an effective method. It should be noted that the grasp of the microsurgical techniques and microsurgical anatomy knowledge has been the key to the success of the operation.