[1]殷尚炯　刘洪泉　王洪生　杜秀玉.前交通动脉动脉瘤的显微手术治疗[J].中国临床神经外科杂志,2015,(09):529-531.[doi:10.13798/j.issn.1009-153X.2015.09.006]
　YIN Shang-jiong,LIU Hong-quan,WANG Hong-sheng,et al.Microsurgical management of anterior communicating artery aneurysms[J].,2015,(09):529-531.[doi:10.13798/j.issn.1009-153X.2015.09.006]
点击复制

前交通动脉动脉瘤的显微手术治疗()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2015年09期
页码:
529-531
栏目:
论著
出版日期:
2015-09-30

文章信息/Info

Title:
Microsurgical management of anterior communicating artery aneurysms
文章编号:
1009-153X（2015）09-0529-03
作者:
殷尚炯　刘洪泉　王洪生　杜秀玉
075000 河北张家口，解放军第251医院神经外科
Author(s):
YIN Shang-jiong;  LIU Hong-quan;  WANG Hong-sheng;  DU Xiu-yu.
Department of Neurosurgery, The 251st Hospital, PLA, Zhangjiakou 075000, China
关键词:
前交通动脉动脉瘤; 显微手术; 疗效
Keywords:
Anterior communicating artery;  Aneurysms;  Microsurgery;  Curative effect
分类号:
R 743.9; R 651.1+2
DOI:
10.13798/j.issn.1009-153X.2015.09.006
文献标志码:
A
摘要:
目的 探讨前交通动脉动脉瘤的外科治疗方法。方法 对2009年1月至2014年7月手术夹闭的121例前交通动脉瘤的临床资料进行回顾性分析，Hunt-Hess分级0级3例，Ⅰ级20例，Ⅱ级57例，Ⅲ级 29例，Ⅳ级12例。按动脉瘤瘤顶指向分类，前交通动脉瘤主要分为5型，向前12 例，向下13例，向上49例，向后23例，多方向24例。结果 121例138个前交通动脉瘤中，手术成功夹闭135个；2例（3个动脉瘤）手术夹闭困难，行动脉瘤包裹。有12例患者手术夹闭后由于脑积水而行脑室-腹腔分流术。出院时根据GOS评分判断预后：恢复良好101例，中残11例，重残5例，死亡4例（因手术后发生严重脑血管痉挛，顽固性颅内压增高而死亡）。结论 夹闭手术对于前交通动脉动脉瘤的治疗是安全有效的，入路主要以翼点入路为主，但手术夹闭要结合多种因素个体化对待。
Abstract:
Objective To explore microsurgical treatment of anterior communicating artery (ACoA) aneurysms. Methods The clinical data of 121 patients with 138 ACoA aneurysms, who received the surgical clipping of the aneurysms from January, 2009 to July 2014, were analyzed retrospectively. Hunt and Hess scale was grade 0 in 3 patients, grade Ⅰ in 20, grade Ⅱ in 57, grade Ⅲ in 29, grade Ⅳ in 12. The definite diagnosis was made by 64 rows helical 3D-CTA examination in all the patients. The aneurysmal domes projected forward in 12 patients, downward in 13, upward in 49, backward in 23 and in many directions in 24. Results Of 138 aneurysms, 135 were successfully clipped, 2 were wrapped and 1 was not treated. The ventriculoperitoneal shunting were performed in 12 patients with postoperative hydrocephalus. According to the GOS on discharge from the hospital, of 121 patients, 101 were recovered well; 11 were mildly disabled, 5 severely disabled and 4 died from severe cerebrovascular spasm or refractory intracranial hypertension. Conclusions Surgical clipping was a safe and effectively method to treat ACoA aneurysms. The pterional approach meets the clinical requirements of the surgery for ACoA aneurysms, which should be individualized according to many factors related to ACoA aneurysms.

参考文献/References:

[1] Hyun SJ, Hong SC, Kim JS, et al. Side selection of the pte- rional approach for superiorly projecting anterior communi- cating artery aneurysms [J]. J Clin Neurosci, 2010, 17(5)： 592-596.
[2] 康德智，兰　青，林　元，等. 翼点锁孔入路显微手术治疗 颅内前循环动脉瘤[J]. 中华神经医学杂志，2006，5（2）： 165-168.
[3] Wang H, Luo L, Ye Z, et al. Clipping of anterior communi- cating artery aneurysms in the early post-rupture stage via transorbital keyhole approach-Chinese neurosurgical experience [J]. Br J Neurosurg, 2015. Epub ahead of print.
[4] 黄传平，林　煜，赖裕通，等. 前交通动脉动脉瘤分型与手 术入路选择[J]. 中国临床神经外科杂志，2014，19：648- 650.
[5] 颜明布，丰育功，李环廷，等. 前交通动脉动脉瘤手术时机 与疗效的相关性分析（附48例报告）[J]. 中国临床神经外 科杂志，2014，19：548-550.
[6] 申彦杰，马廉亭，杨　铭，等. 前交通动脉动脉瘤的诊治分 析[J]. 中国临床神经外科杂志，2014，19：552-554.
[7] 周　济，易　良，许民辉. 早期显微手术夹闭治疗前交通 动脉瘤167例及其预后影响因素分析[J]. 中国临床神经 外科杂志，2014，19：142-144.
[8] 江普查，马　超，陈新军，等. 78例前交通动脉动脉瘤手 术治疗的临床分析[J]. 中国临床神经外科杂志，2012， 17：725-726，729.
[9] 王少兵，卢俊章，吴佩涛，等. 经翼点入路显微手术治疗前 交通动脉动脉瘤62例的临床体会[J]. 中国临床神经外科 杂志，2012，17：732-734.
[10] 黄朝觉，黄　玮，杨雷霆，等. 51例前交通动脉瘤动脉的 显微手术疗效分析[J]. 中国临床神经外科杂志，2013， 17：335-336，340.
[11] Hernesniemi J, Dashti R, Lehecka M, et al. Microneuro- surgical management of anterior communicating artery aneurysm [J]. Surg Neurol, 2008, 70: 8-29.
[12] Kiyofuji S, Inoue T, Tamura A, et al. Combined interhemis- pheric and pterional approach for ACOM and left MCA aneurysms [J]. Neurosurg Focus, 2015, 38(VideoSuppl1): Video15.
[13] 廖毅超，胡国庆，顾建华，等. 3D-CTA在破裂颅内动脉瘤 诊断和手术中的应用[J]. 中国临床神经外科杂志，2011， 16（5）：296-297.
[14] 石　鑫，姜　梅，郝玉军，等. 3D-CTA、3D-DSA对颅内动 脉瘤临床诊断价值的对比[J]. 中国临床神经外科杂志， 2010，15（2）：69-72.

相似文献/References:

[1]林国中　王振宇　马长城　赵　薇.神经电生理监测下显微手术切除脊髓髓内肿瘤[J].中国临床神经外科杂志,2015,(11):647.[doi:10.13798/j.issn.1009-153X.2015.11.003]
　LIN Guo-zhong,WANG Zhen-yu,MA Chang-cheng,et al.Clinical value of intraoperative electrophysiological monitoring to microsurgery for intramedullary spinal tumors[J].,2015,(09):647.[doi:10.13798/j.issn.1009-153X.2015.11.003]
[2]谢京城　王振宇　陈晓东.骶管终丝脊膜囊肿合并脊髓拴系综合征的诊断和治疗[J].中国临床神经外科杂志,2015,(11):651.[doi:10.13798/j.issn.1009-153X.2015.11.004]
　XIE Jing-cheng,WANG Zhen-yu,CHEN Xiao-dong.Diagnosis and surgical treatment of sacral spinal meningeal cysts of fila terminale complicated with tethered spinal cord syndrome[J].,2015,(09):651.[doi:10.13798/j.issn.1009-153X.2015.11.004]
[3]于　涛　黄正通　王振宇.椎管内脊膜囊肿的临床特征和治疗方法[J].中国临床神经外科杂志,2015,(11):654.[doi:10.13798/j.issn.1009-153X.2015.11.005]
　YU Tao,HUANG Zheng-tong,WANG Zhen-yu.Clinical features and treatment of intraspinal arachnoid cysts[J].,2015,(09):654.[doi:10.13798/j.issn.1009-153X.2015.11.005]
[4]谢宝树　王　宇　贾　锋　张　林　殷玉华.神经电生理监测下显微手术治疗成人脊髓栓系综合征[J].中国临床神经外科杂志,2015,(11):658.[doi:10.13798/j.issn.1009-153X.2015.11.006]
　XIE Bao-shu,WANG Yu,JIA Feng,et al.Intraoperative electrophysiological monitoring-guided microsurgery on tethered spinal cord syndrome in adults[J].,2015,(09):658.[doi:10.13798/j.issn.1009-153X.2015.11.006]
[5]赵东升　王正君　孙刚锋　费　舟　姬西团　李　娟　万晓强.椎管内畸胎瘤的诊断与治疗[J].中国临床神经外科杂志,2015,(11):661.[doi:10.13798/j.issn.1009-153X.2015.11.007]
　ZHAO Dong-sheng,WANG Zheng-jun,SUN Gang-feng,et al.Dignosis and treatment of intraspainal teratomas[J].,2015,(09):661.[doi:10.13798/j.issn.1009-153X.2015.11.007]
[6]陈晓东　于　涛　王振宇.脊髓髓内神经鞘瘤的诊断与治疗[J].中国临床神经外科杂志,2015,(11):670.[doi:10.13798/j.issn.1009-153X.2015.11.010]
　CHEN Xiao-dong,YU Tao,WANG Zhen-yu.Diagnosis and treatment of intramedullary spinal schwannomas[J].,2015,(09):670.[doi:10.13798/j.issn.1009-153X.2015.11.010]
[7]马　磊　张海红　张　威　衡立君　孙树凯　贾　栋.眶上锁孔入路手术切除前颅底脑膜瘤的临床效果[J].中国临床神经外科杂志,2015,(11):680.[doi:10.13798/j.issn.1009-153X.2015.11.013]
　MA Lei,ZHANG Hai-hong,ZHANG Wei,et al.Microsurgery through supraorbital keyhole approach for anterior cranial fossa meningiomas[J].,2015,(09):680.[doi:10.13798/j.issn.1009-153X.2015.11.013]
[8]李春坡　郑　军　李海元　边　涛　韩安国.侧脑室三角区小型脑膜瘤的显微外科治疗[J].中国临床神经外科杂志,2015,(11):694.[doi:10.13798/j.issn.1009-153X.2015.11.018]
[9]张兆斯　但　炜　王　刚　周　超　孙　超　谢延风　石全红　詹　彦.咪达唑仑和丙泊酚诱导麻醉对继发性癫痫术中皮层脑电图的影响[J].中国临床神经外科杂志,2016,(05):261.[doi:10.13798/j.issn.1009-153X.2016.05.002]
　ZHANG Zhao-si,DAN Wei,WANG Gang,et al.Effects of midazolam or propofol used for induction of anesthesia on intraoperative ECoG in patients with secondary epilepsy[J].,2016,(09):261.[doi:10.13798/j.issn.1009-153X.2016.05.002]
[10]赵　平　王雄伟　汪　雷　马金阳.显微手术和血管内栓塞术治疗颅内动脉瘤的疗效分析[J].中国临床神经外科杂志,2016,(05):281.[doi:10.13798/j.issn.1009-153X.2016.05.008]
　ZHAO Ping,WANG Xiong-wei,WANG Lei,et al.Effect of endovascular treatment on intracranial aneurysms: a comparison with microsurgery[J].,2016,(09):281.[doi:10.13798/j.issn.1009-153X.2016.05.008]
[11]冯　力　李中林　纪培志.经大脑前纵裂入路手术夹闭前交通动脉动脉瘤18例[J].中国临床神经外科杂志,2015,(12):746.[doi:10.13798/j.issn.1009-153X.2015.12.014]
[12]张显强　刘胜初　杨建雄　廖驭国　罗　捷　杨　华.前交通动脉动脉瘤70例治疗分析[J].中国临床神经外科杂志,2015,(07):422.[doi:10.13798/j.issn.1009-153X.2015.07.013]
[13]黄进兴,叶敏,李劲松,等.显微手术治疗前交通动脉动脉瘤33例[J].中国临床神经外科杂志,2017,(07):489.[doi:10.13798/j.issn.1009-153X.2017.07.014]
[14]杨钰桢　郝解贺　万大海.神经纤维瘤病Ⅰ型并发颅内动脉瘤1例[J].中国临床神经外科杂志,2021,26(02):142.[doi:10.13798/j.issn.1009-153X.2021.02.029]

更新日期/Last Update: 2015-09-30