床突旁复杂动脉瘤术中出血的防与止

目的 探讨颈内动脉前床突旁动脉瘤术中瘤体破裂出血的预防和控制.方法 回顾性分析3例术中破裂的眼动脉瘤的手术经验.手术均采用翼点入路,床突旁动脉瘤病例预先暴露颈总、颈内、颈外动脉以备临时阻断.从硬脑膜内快速咬除前床突,以显露动脉瘤的近侧角.术中监测脑电图和体感诱发电位,并采用术中超声多普勒检查动脉血流.结果 2例动脉瘤直接夹闭,1例行动脉瘤孤立术.术后行检查加入数字减影血管造影(DSA),3例动脉瘤均不显影.结论 充分显露、合理应用临时阻断技术,以及术中应用电生理监测和超声多普勒检查等辅助措施,能够取得动脉瘤的满意处理,减少脑损伤.

Prevention and control intraoperative aneurysmal rupture hemorrhage of internal carotid arteryanterior paraclinoid aneurysms

Objective To study the internal carotid artery anterior paraelinoid aneurysms intraoperative aneurysmal rupture hemorrhage prevention and control. Methods A retrospective analysis of 3 cases of rupture of the ophthalmic artery aneurysm operation experience. Operation using the pterional approach, paraclinoid aneurysm case prior exposure of the carotid, internal carotid and carotid artery for temporary occlusion. From the dura mater in a quick bite except the anterior clinoid process, to expose the aneurysm of the proximal angle. Intraoperative monitoring of electroencephalography and somatosensory evoked potentials, and the use of intraoperative Doppler ultrasound examination of artery blood flow. Results Two cases of aneurysm direct clipping, 1 routine aneurism isolation technique. Postoperative DSA examination, 3 cases of aneurysms are not developing. Conclusion Sufficient exposure, rational temporary occlusion of parent artery, as well as the application of intraoperative electrophysiological monitoring and ultrasound Doppler examination and other auxiliary measures, can obtain satisfactory treatment of aneurysms and reduce brain injury.