前组循环动脉瘤的显微外科手术

目的 研究和改进显微外科手术技术，以提高前组循环动脉瘤的手术疗效。方法 回顾性分析手术治疗77例85个前组循环动脉瘤。在诊断上、术前和术后采用3D－CTA以发现和勾划动脉瘤，并与DSA对照。在手术上采用颅底入路、近侧载瘤动脉暂时性阻断、动脉瘤内减压、多瘤夹夹闭、瘤颈逐步缩窄、动脉瘤切除等技术。结果 出院时优良者65例（85％）、轻残6例、重残3例、死亡3例，其中Hunt-Hsess分级0-Ⅲ级者无手术死亡。结果 3D－CTA技术能清楚地显示动脉瘤的形状、大小、瘤颈、以及与附近血管和骨质的关系，有助于术者计划手术方法。在前组循环动脉瘤的显微手术中我们采用和改进的一些手术技术，对于提高手术效果很有帮助。

Microsurgical treatment in aneurysms of anterior circulation

Objective　The dignositic and operative technique had been made better in order to improve its results in aneurysms of the anterior circulation. Methods　A retrospective analysis had been made of 77 patients with 85 aneurysms of the anterior circulation operated on from January 1990 to September 1997.3D-CTA has been used to detection and delineation of aneurysm pre- and postoperatively. A series of improved operative technique has been used,suchas cranial base approaches, temporary artery occlusion, intra-aneurysm decompression, obliteration of aneurysm with multiple clippes, stepwise coagulation clipping, resection of aneurysms and so on. Results　Outcome was considerded good in 65 cases (85%), fair in 6 cases, poor in 3 cases and dead in 3 cases. There was no postoperative death in patient with Hunt and Hess 0-Ⅲ grade. Conclusions　 3D-CTA is useful in delineating the sharp, size and neck of aneurysms, as well as its relation to near arteries and to cranial base structures. It is very helpful to improve operative result that we have used some special operative techniques in surgery for aneurysms of anterior circulation.