眶上外入路联合腰大池引流与翼点入路治疗急性期前循环动脉瘤破裂伴发脑积水的临床对比分析

目的对比眶上外入路联合腰大池引流与翼点入路治疗急性期颅内前循环动脉瘤破裂伴发脑积水的手术治疗效果。 方法选择自2017年1月至2019年6月四川省医学科学院·四川省人民医院神经外科收治的48例急性期颅内前循环动脉瘤破裂伴发脑积水患者作为研究对象，依据手术方式分为2组，每组24例。观察组采用眶上外入路联合腰大池引流术式，对照组采用翼点入路组。评估2组患者的临床指标变化与手术效果，根据简易精神评价量表评价患者术后记忆力、定向力、回忆能力、语言能力。 结果观察组的手术时间和住院时间较对照组短，差异具有统计学意义（P<0.05）。观察组的术中出血量与对照组比较，差异无统计学意义（P>0.05）。观察组术中颞浅动脉损伤和脑组织牵拉损伤较对照组少，颞肌萎缩和术后脑积水的发生率较对照组低，差异具有统计学意义（P<0.05）。观察组患者术后记忆力、定向力、回忆能力、语言能力与对照组比较，差异均具有统计学意义（P<0.1）；注意力和计算力与对照组比较，差异无统计学意义（P>0.1）。 结论眶上外入路联合腰大池引流治疗急性期颅内前循环动脉瘤破裂伴发脑积水，能有效减少术中脑挫伤、术后并发症，有利于患者快速康复，提高患者生存质量。

Clinical comparative analysis of supraorbital external approach combined with lumbar cisterna drainage and pterional approach in the treatment of acute intracranial anterior circulation ruptured aneurysm with hydrocephalus

ObjectiveTo investigate the effect of supraorbital approach combined with lumbar cistern drainage and pterional approach in the treatment of acute intracranial anterior circulation ruptured aneurysm with hydrocephalus. MethodsForty-eight patients with ruptured anterior circulation complicated by hydrocephalus were admitted to Department of Neurosurgery of Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital from January 2017 to June 2019 were selected as the research objects. The patients were randomly divided into observation group (supraorbital approach surgery combined with lumbar cistern drainage) and control group (pterional approach surgery) with 24 cases in each group. The change time and surgery effect of clinical indicators in the two groups were evaluated. The memory, orientation, recall and language ability were evaluated according to the mini mental status examination (MMSE). ResultsThe operation time and hospitalization time of the observation group were shorter than those of the control group, and the differences were statistically significant (P<0.05). There was no significant difference in intraoperative blood loss between the observation group and the control group (P>0.05). Intraoperative superficial temporal artery injury and brain tissue pulling injury in the observation group were less than those in the control group, and the differences were statistically significant (P<0.05). The incidence of temporalis atrophy and postoperative hydrocephalus in the observation group were lower than that in the control group, and the differences were statistically significant (P<0.05). According to MMSE score, postoperative memory, orientation, recall ability and language ability of the patients in the observation group were all different from those in the control group (P<0.1); there was no significant difference in attention and computation ability between the observation group and the control group (P>0.1). ConclusionSupraorbital approach combined with lumbar cisterna drainage in the treatment of acute intracranial anterior circulation ruptured aneurysm with hydrocephalus can effectively reduce intraoperative cerebral contusion and postoperative complications, which is conducive to the rapid recovery of patients and improve the quality of life of patients.