经翼点入路显微手术治疗前循环动脉瘤21例

目的探讨经翼点入路前循环动脉瘤手术治疗相关问题。方法经CTA或DSA明确诊断的颅内前循环动脉瘤患者21例，回顾性分析应用翼点入路显微手术治疗21例前循环动脉瘤的临床资料，对手术时机与近期疗效进行评价。结果术前Hunt-Hess分级I级7例，Ⅱ级9例，Ⅲ级4例，Ⅳ级1例。成功夹闭动脉瘤颈21例，术中动脉瘤破裂4例。随访2～12个月，良好16例，轻残3例，重残1例．死亡1例。本组近期疗效良好率为85．8％（20／21），病死率为6．6％（1／21），术中破裂发生率19．05％（4／21）。结论Hunt-Hess分级Ⅰ-Ⅲ级前循环动脉瘤患者应尽早手术，翼点入路是治疗颅内前循环动脉瘤的经典入路；控制性降压可提高手术的安全性；熟练的显微外科技术是手术成功的保证。

The microsurgical treatment patient with 21 cases of anterior circulation aneurysms by pterional approach

Objective To investigate the related issues on surgical treatment of anterior circulation aneurysms by pterion approach. Methods 21 patients were diagnosed with intracranial anterior circulation aneurysms by CTA or DSA, and were treated by micro-surgery of pterion approach, the clinical data on 21 patientswas analysed retrospectively, and surgical timing and short-term effect was evaluated. Results The results of preoperative Hunt-Hess grade respectively is grade Ⅰ in 7 patients, grade Ⅱ 9 cases, grade Ⅲ 4 cases, grade Ⅳ 1 cases. The 21 patients were taken operations successfully ,4 aneurysms ruptured and bleeded during operations.Followed-up for 2 ～ 12 months, 16 cases were in good ,3 cases was light residual, 1 case was severe disability and 1 case was dead. According to Short-term effect on this group ,the good rate was 85.8% (20/21), the mortality was 6. 6% ( 1/21 ), the intraoperative rupture rate was 19. 05 % (4/21 ). Conclusion The patient with anterior circulation aneurysm in Hunt-Hess grade Ⅰ～Ⅲ should be taken an operation as soon as possible, the pterional approach is the classical approach in the treatment of anterior circulation intracranial aneurysms, the controlled hypotension can increase the safety of operation, the skillful microsurgical technique involves guarantee of successful surgery.