神经内镜辅助显微外科治疗颈内动脉动脉瘤

目的探讨神经内镜辅助显微外科治疗颈内动脉动脉瘤的临床价值。方法选择未破裂的动脉瘤和已破裂的、但蛛网膜下腔出血已吸收的Hunt—HessⅠ～Ⅱ级的病例22例共25个动脉瘤。经翼点锁孔入路5例，眶上锁孔入路3例，常规翼点入路14例。经一侧同时夹闭对侧颈内动脉动脉瘤2例。手术显微镜下初步暴露动脉瘤，置入不同视角的硬性内镜，辨认出手术显微镜下为死角的载瘤动脉的重要分支，分离瘤颈并夹闭动脉瘤，在内镜下检查夹闭的效果。术后常规复查DSA或CTA。结果本组均完全夹闭动脉瘤，在夹闭动脉瘤前或后神经内镜能提供有用的信息为18例，占81．8％，夹闭后经神经内镜调整的有4例，占16％，术中2例动脉瘤破裂，术后1例暂时性动眼神经麻痹，无手术死亡病例。结论神经内镜辅助显微外科治疗颈内动脉动脉瘤可减少显微镜下的死角．保留载瘤动脉的重要分支，减少术中动脉瘤的破裂及载瘤动脉的阻断时间，降低术后并发症的发生率，提高疗效。

Endoscope-assisted microneurosurgery for interal carotid artery aneurysms

Objective To evaluate the efficacy of neuro-endoscope in microneurosurgery for intcral carotid artery aneurysms,analyzing its benefits,and disadvantage.Methods The endoscopic technique was applied during microsurgery in 22 patients with 25 aneurysms. An ruptured aneurysms in 17 patients produced Hunt and Hess Grade Ⅰ or Ⅱ subarachnoid hemorrhage.After initial, expo sure achieved with the aid of a microscope,the rigid endoscope was introduced to confirm the regional anatomy,including the aneurysm neck and adjacent structures.The necks of 25 aneurysms were clipped using microscopic control.After clipping;the position of the clip and nearby structures were inspected using the endoscope.Results Postoprative angiograms show complete obliteration of 25 aneurysms.Use of the neuroendoscopic provided useful information that further clarified the regional anatomy in 18 cases （81.8%）either before or after neck clipping. In four cases（16%）,thc surgeons reapplied the clip on the basis of neuroendoscopic information obtained after initial clipping.There was one case in which surgical complication was possibly related to the endoscopic procedures（ transient oculomotor palsy）.Oprative mortality was O.Conclusion This method allows for direct dissection of the aneurysm,perforating vessels,and the main trunk in an area not visible through the microscope＇ s eyepiece ,and prevents the possibility of the aneurysm being ruptured and also reduces the use of temporary clipping,and reduces operative morbidity,and promises better surgical results.