[1]王　潞　李　俊　陈　文　徐　浩　何　苗　幸　标.显微手术治疗前交通动脉动脉瘤（附115例报道）[J].中国临床神经外科杂志,2017,(05):299-301.[doi:10.13798/j.issn.1009-153X.2017.05.005]
　WANG Lu,LI Jun,CHEN Wen,et al.Microsurgery for anterior communicating artery aneurysms (report of 115 cases)[J].,2017,(05):299-301.[doi:10.13798/j.issn.1009-153X.2017.05.005]
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显微手术治疗前交通动脉动脉瘤（附115例报道）()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2017年05期
页码:
299-301
栏目:
论著
出版日期:
2017-05-20

文章信息/Info

Title:
Microsurgery for anterior communicating artery aneurysms (report of 115 cases)
文章编号:
1009-153X（2017）05-0299-03
作者:
王　潞　李　俊　陈　文　徐　浩　何　苗　幸　标
430010，武汉市中心医院神经外科
Author(s):
WANG Lu;  LI Jun;  CHEN Wen;  XU Hao;  HE Miao;  XING Biao.
Department of Neurosurgery, Wuhan Municipal Central Hospital, Wuhan 420010, China
关键词:
颅内动脉瘤; 前交通动脉; 显微手术; 翼点入路; 疗效
Keywords:
Anterior communicating artery;  Intracranial aneurysms;  Microneurosurgery;  Pterional approach;  Curative effects
分类号:
R 743.9; R 651.1+2
DOI:
10.13798/j.issn.1009-153X.2017.05.005
文献标志码:
A
摘要:
目的 探讨前交通动脉动脉瘤显微手术治疗的临床效果。方法 回顾性分析2009年1月至2016年1月显微手术治疗的115例前交通动脉动脉瘤的临床资料，术前均行3D-CTA（和/或）3D-DSA检查并模拟手术入路，经翼点入路施行动脉瘤夹闭。结果 术后随访3个月~3年，按GOS评分评定预后，恢复良好89例，中残18例，重残4例，死亡4例。术后发生严重脑血管痉挛4例，行去骨瓣减压术，其中2例术后3月行颅骨修补术时，GOS评分5分；2例并发脑积水行脑室-腹腔分流术，6月后随访，1例GOS评分4分，1例3分。结论 三维影像模拟手术入路可充分了解动脉瘤形态及穿支血管情况，采用翼点入路手术夹闭前交通动脉动脉瘤，可降低并发症发生率，提高病人生存质量。
Abstract:
Objective To study the clinical effect of microsurgery on anterior communicating artery aneurysms. Methods The clinical data of 115 patients with anterior communicating artery aneurysms treated in Wuhan Municipal Central Hospital from January, 2009 to January, 2016 were analyzed retrospectively. 3D-CTA and (or) 3D-DSA was performed before the operation in all the patients, in whom the aneurysms were clipped by neurosurgery via pterional approach. 3D-simulated operations were performed in all the patients. The preoperative diagnosis, microsurgical aneurysm exposure technique, the prevention of the intraoperative complications and curative effects were analyzed. Results Of 115 patients with anterior communicating artery aneurysms, 27 belonged in Hunt-Hess grade I, 45 in the grade Ⅱ, 31 in the grade Ⅲ, 9 in the grade Ⅳ and 3 in the grade Ⅴ before the surgery. Postoperative follow-up period was from 3 months to 3 years. Of these 115 patients, 89 were recovered well, 18 moderately disabled, 4 severely disabled and 4 died according to GOS grading system. Conclusions The 3D-simulated operation is helpful to the preoperative understanding of aneurysm morphology and perforating vessels. The postoperative complications can be decreased and life quality can be enhanced by the microneurosurgery via the pterional approach in the patients with anterior communicating artery aneurysms.

参考文献/References:

[1] Solomon RA. Anterior communicating artery aneurysms [J]. Neurosurgery, 2001, 48(1): 119-123.
[2] 张　波，王任直. 前交通动脉瘤的手术处理 [J]. 神经疾病 与精神卫生，2004，4：41l-412.
[3] Chen LK, Agrawal A, Kato Y, et al. Role of aneurysm pro- jection in "A2" fork orientation for determining the side of surgical approach [J]. Acta Neurochir (Wien), 2009, 151(8): 925-933.
[4] 李　祥，于如同，谷　佳，等. 3D-CTA在颅内前循环动脉 动脉瘤临床诊断中的应用[J]. 中华神经外科杂志，2015， 31（6）：557-559.
[5] 王　真，祝向东，王　林，等. 单侧入路处理颅内动脉瘤的 临床体会[J]. 中华神经外科杂志，2015，31（5）：470-471.
[6] Ross YB, Beenen LF, Groen RJ, et al. Timing of surgery in patients with aneurismal subarachnoid hemorrhage: rebleeding is still the major cause o f poor outcome in neurosurgical units that aim at early surgery [J]. Neurol Neurosurg Psychiatry, 1997, 63: 490-493.
[7] van der Zwan A. How I do it: non-occlusive high flow bypass surgery [J]. Acta Neurochir Suppl, 2014, 119: 71-76.
[8] Sheth SA, Hausrath D, Numis AL, et al. Intraoperative rerupture during surgical treatment of aneurismal subarach- noid hemorrhage is not associated with an increased risk of vasospasm [J]. J Neurosurg, 2014, 120(2): 409-414.
[9] 李　兵，李江安，季卫阳，等. 前循环动脉瘤夹闭术中分离 前期动脉瘤破裂的处理[J]. 中华神经外科杂志，2015，31 （8）：772-775.
[10] Michael TI，Rose D. Efect of the neuosurgeong surgical experience on outcomes from intraoperative aneurysmal rupture [J]. Neurosurgry, 2005, 57: 9-15.

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更新日期/Last Update: 2017-05-20