显微手术治疗大脑中动脉动脉瘤46例临床分析

目的探讨大脑中动脉动脉瘤的显微手术技巧及临床疗效。方法回顾分析显微手术治疗的46例大脑中动脉动脉瘤的临床资料,44例有动脉瘤破裂出血的临床表现,按Hunt-Hess分级：0～Ⅰ级6例,Ⅱ级17例,Ⅲ级13例,Ⅳ级9例,Ⅴ级1例。64排螺旋CT血管造影（CTA）确诊,动脉瘤位于大脑中动脉主干4例,分叉部41例,远端1例。46例均行显微手术治疗,对多发动脉瘤采取早期与择期、一期与分期相结合的方法处理,原则是先处理破裂动脉瘤,再处理未破裂动脉瘤。结果动脉瘤夹闭41例,动脉瘤夹闭＋包裹4例,夹闭一侧动脉瘤、另一侧动脉瘤未处理1例。依据格拉斯哥预后量表（GOS）判断预后：优良36例,轻残6例,重残2例,死亡2例。结论显微外科手术治疗大脑中动脉动脉瘤效果显著。熟悉大脑中动脉动脉瘤的解剖特征有助于减少术中血管损伤,降低术后神经功能障碍发生率。

Clinical Analysis of Microsurgical Treatment of 46 patients with Middle Cerebral Artery Aneurysms

Objective To discuss the microsurgical skills and clinical effectiveness of middle cerebral artery（MCA） aneurysms.Methods 46 patients with MCA aneurysms following microsurgical operation in our hospital received retrospective analysis,and 44 patients showed clinical manifestations of aneurysmal rupture.According to Hunt-Hess classification,6 cases were of grade 0～Ⅰ,17 cases of grade Ⅱ,13 cases of grade Ⅲ,9 cases of grade Ⅳ,1 case of grade Ⅴ.All patients underwent a definite diagnosis by 64 rows helical CT angiography（CTA）.The aneurysms were located in trunk in 4 cases,bifurcation in 41 cases,remote in 1 case.46 patients underwent microsurgical management and the multiple intracranial aneurysms were treated with the method of combining early-stage with selected-stage operation and one-stage with two-stage operation,the operating principle was that the ruptured aneurysm should be treated first and the unruptured aneurysm second.Results Clipping was carried out in 41 cases,clipping plus wrapping in 4 cases,clipping in one side aneurysm and another side case of aneurysm was left untreated.According to Glasgow Outcome Scale（GOS）,the surgical outcomes were good in 36 cases,light disability in 6 cases,severe disability in 2 case,and 2 deaths.Conclusion Microsurgical operations are effective in the treatment of MCA aneurysms.A good knowledge of regional surgical anatomy of MCA aneurysms can help to avoid the damage of the arteries and reduce postoperative neurological deficits.