大脑前动脉A1段动脉瘤的手术处理.PDFVIP

J South Med Univ, 2016, 36(11): 1521-1526 doi 10.3969/j.issn. 1673-4254.2016.11.12 ·1521 · 临床研究 大脑前动脉大脑前动脉AA11 段动脉瘤的手术处理段动脉瘤的手术处理 1 1 1 1 1 1，2 王华伟 ，薛 哲 ，马玉栋 ，王文鑫 ，武 琛 ，孙正辉 1 2 解放军总医院神经外科，北京 100853；解放军总医院海南分院神经外科，海南 三亚 572013 摘要：目的 回顾性分析手术治疗的23 例大脑前动脉近端（A 1段）动脉瘤患者的病例资料，探讨手术治疗的技巧和方法。方法 2004 年1月~2014 年12月期间共手术治疗1437例颅内动脉瘤，选择其中A 1段动脉瘤23 例（1.6%），所有患者术前均经数字减影 血管造影术（DSA）或CT 血管造影（CTA）明确诊断，并行手术夹闭治疗颅内A 1段动脉瘤，术后行“3H”疗法预防血管痉挛，于术 后第6、12、48、60个月门诊随访，行CT 血管造影（CTA）复查，并使用Glasgow 预后分级（GOS）评价术后疗效。结果 所有A 1动 脉瘤均采取翼点入路开颅手术完全夹闭；有7 名（30.43% ）患者为多发动脉瘤；术后平均随访时间38.52 （6~60）个月，平均 Glasgow 预后分级为4.83分（Ⅲ~ Ⅴ级）。结论 术前仔细分析影像资料对于其诊断和治疗至关重要。手术治疗的关键是保护穿 支动脉不受损伤，术中充分打开侧裂并进行载瘤动脉临时阻断可使手术安全、有效。 关键词：大脑前动脉；动脉瘤；显微手术 Surgical management of proximal anterior cerebral artery (A1) aneurysms 1 1 1 1 1 1, 2 WANG Huawei , XUE Zhe , MA Yudong , WANG Wenxin , WU Chen , SUN Zhenghui 1Department of Neurosurgery, General Hospital of PLA, Beijing 100853, China; 2Department of Neurosurgery, Hainan Branch of General Hospital of PLA, Sanya 572013, China Abstract ：Objective To review our experience in surgical management of proximal anterior cerebral artery (A1) aneurysms in 23 patients. Methods Between January, 2004 and December, 2014, 23 patients (1.6%) with A1 aneurysms diagnosed by CTA or DSA were treated surgically. The “3H”therapy was adopted for postoperative prevention of cerebrovascular spasm. All the patients were followed up and examined with cerebrovascular CTA at 6, 12, 48 and 60 months after the operation with their Glasgow Outcome Scale score recorded. Results The patients consisted of 15 men and 8 women with an age range of 16 to 72 years (mean 51.3 years). The average diameter of the aneurysms was 5.8 mm, ranging from 3.2 to 9.7 mm. Twenty-tw