前交通动脉动脉瘤分型与手术入路选择

目的探讨前交通动脉瘤的分型及其在两种手术入路选择中的价值。方法根据术前DSA和/或CTA,以前交通动脉及双侧大脑前动脉A2段为参考平面,将前交通动脉动脉瘤分为Ⅰ~Ⅴ型：Ⅰ型,瘤体朝前;Ⅱ型,瘤体朝下;Ⅲ型,瘤体朝后;Ⅳ型,瘤体朝上;Ⅴ型,瘤体多朝向。从2012年1月至2014年5月采用显微手术夹闭前交通动脉动脉瘤52例,采取翼点入路28例,其中Ⅰ型动脉瘤8例,Ⅱ型9例,Ⅲ型3例,Ⅳ型7例、Ⅴ型1例;前纵裂入路24例,其中Ⅰ型5例,Ⅱ型7例,Ⅲ型2例,Ⅳ型10例。结果本组52例均一次性夹闭瘤体,1例夹闭后包裹,其余均夹闭满意。出院时GOS评分4~5分37例,2~3分13例,1分2例。结论Ⅰ型、Ⅱ型两种入路均适合选择,可依个人习惯选择;Ⅲ、Ⅳ、Ⅴ型选择纵裂入路更合适。

Classification of anterior communicating artery aneurysms and selection of surgical approach to them

Objective To explore the classification of the anterior communicating artery（ACo A） aneurysms and surgical approachto them.MethodsAccording to the characteristic of ACo A aneurysms on the preoperative DSA and/or CTA imagings 52 cases of theACo A aneurysms were divided into 5 types, i.e. type Ⅰ aneurysm（aneurismal body pointing forwards）, 13 cases; type Ⅱ（aneurismalbody pointing downwards）, 16 cases; type Ⅲ（aneurismal body pointing backwards）, 5 cases; type Ⅳ（aneurismal body pointingupwards）, 17 cases and type Ⅴ（aneurismal body pointing toward the multi-directions）, 1 case. Of 52 patients with ACo A aneurysms, 28 underwent microsurgery through pterional approach and 24 through the anterior interhemisperic approach. Of 28 aneurysms which wereclipped by the microsurgery through pterional approach, 8 belonged in type Ⅰ aneurysm, 9 in type Ⅱ, 3 in type Ⅲ, 7 in type Ⅳ and 1 intype Ⅴ. Of 24 aneurysms which were clipped by the microsurgery through anterior interhemispheric approach, 5 belonged in type Ⅰaneurysm, 7 in type Ⅱ, 2 in type Ⅲ and 10 in type Ⅳ.ResultsOf 52 Aco A aneurysms, 51 were successfully clipped and 1 was clippedand wrapped. GOS ranged from 4 to 5 points in 37 patients, from 2 to 3 points in 13 and 2 died on discharge from hospital.Conclusions Both the pterional and anterior interhemispheric approaches which are proper for the microsurgery for types Ⅰ and Ⅱ aneurysms may beselected according to the operator habit. The microsurgery through the anterior interhemispheric approach is more proper for types Ⅲand Ⅳ aneurysms.