前交通动脉动脉瘤的显微手术治疗

目的 探讨前交通动脉动脉瘤的外科治疗方法。方法 对2009年1月至2014年7月手术夹闭的121例前交通动脉瘤的临床资料进行回顾性分析，Hunt-Hess分级0级3例，Ⅰ级20例，Ⅱ级57例，Ⅲ级 29例，Ⅳ级12例。按动脉瘤瘤顶指向分类，前交通动脉瘤主要分为5型，向前12 例，向下13例，向上49例，向后23例，多方向24例。结果 121例138个前交通动脉瘤中，手术成功夹闭135个；2例（3个动脉瘤）手术夹闭困难，行动脉瘤包裹。有12例患者手术夹闭后由于脑积水而行脑室-腹腔分流术。出院时根据GOS评分判断预后:恢复良好101例，中残11例，重残5例，死亡4例（因手术后发生严重脑血管痉挛，顽固性颅内压增高而死亡）。结论 夹闭手术对于前交通动脉动脉瘤的治疗是安全有效的，入路主要以翼点入路为主，但手术夹闭要结合多种因素个体化对待。

Microsurgical management of anterior communicating artery aneurysms

Objective To explore microsurgical treatment of anterior communicating artery (ACoA) aneurysms. Methods The clinical data of 121 patients with 138 ACoA aneurysms, who received the surgical clipping of the aneurysms from January, 2009 to July 2014, were analyzed retrospectively. Hunt and Hess scale was grade 0 in 3 patients, grade Ⅰ in 20, grade Ⅱ in 57, grade Ⅲ in 29, grade Ⅳ in 12. The definite diagnosis was made by 64 rows helical 3D-CTA examination in all the patients. The aneurysmal domes projected forward in 12 patients, downward in 13, upward in 49, backward in 23 and in many directions in 24. Results Of 138 aneurysms, 135 were successfully clipped, 2 were wrapped and 1 was not treated. The ventriculoperitoneal shunting were performed in 12 patients with postoperative hydrocephalus. According to the GOS on discharge from the hospital, of 121 patients, 101 were recovered well; 11 were mildly disabled, 5 severely disabled and 4 died from severe cerebrovascular spasm or refractory intracranial hypertension. Conclusions Surgical clipping was a safe and effectively method to treat ACoA aneurysms. The pterional approach meets the clinical requirements of the surgery for ACoA aneurysms, which should be individualized according to many factors related to ACoA aneurysms.