颅内前循环破裂动脉瘤的显微手术处理策略

摘要

Objective To discuss a microsurgical scheme to treat ruptured anterior circulation aneurysm, including operation time, surgical approach and key steps involved.Methods A total of 34 patients who were admitted into our hospital due to anterior circulation aneurysm were enrolled, where they underwent microsurgery through a pterional ap-proach.According to the severity of their subarachnoid hemorrhage, all patients were classified into grade I-II (17 ca-ses), grade III (11) and grade IV (6) based on the Hunt and Hess scale before operation.Results Postoperative re-examination showed successful clipping in 25 patients through CTA and 7 patients through DSA ( 2 patients were dis-charged and unable to re-examine due to their critical condition) .After microsurgery, 25 patients recovered well, 3 be-came slightly disable, 4 was severely disable, and 2 discontinued to treat.Conclusion Microsurgical clipping is a safe, effective technique to deal with ruptured anterior circulation aneurysm.Rational operation scheme and proper periopera-tive management can effectively enhance the microsurgical effects.%目的 探讨破裂的颅内前循环动脉瘤的显微手术时机、手术入路、手术临床要点. 方法 翼点入路显微手术方法治疗破裂的颅内前循环动脉瘤34例,依据Hunt和Hess蛛网膜下腔出血分级,Ⅰ、Ⅱ级17例,Ⅲ级11例,Ⅳ级6例. 结果 术后25例复查CTA、7例复查DSA显示:夹闭成功(有2例因病情危重自动出院未能复查). 恢复良好25 例,轻度残疾3例,重度残疾4例,放弃治疗自动出院2例. 结论 显微手术夹闭是治疗颅内前循环破裂动脉瘤的有效、安全的措施,根据病情制定合理的手术策略及加强围手术期管理能有效提高手术效果.