大脑中动脉分叉处动脉瘤的显微外科手术

Microsurgical treatment for middle cerebral artery bifurcation aneurysms

摘要:

目的：总结显微外科手术夹闭大脑中动脉分叉处动脉瘤的临床经验和体会。方法：回顾性分析28例经显微外科手术治疗的大脑中动脉分叉处动脉瘤患者的临床资料、手术过程，总结经验。结果：28例患者共30个动脉瘤，其中5例伴有脑内血肿；根据计算机断层血管造影（computed tomography angiography，CTA）或数字减影血管造影（digital subtraction angiography，DSA）评估动脉瘤的大小、形态、朝向和与分叉血管的关系，精心设计显微手术；术后随访6~12月，格拉斯哥预后分级（Glasgow outcome scale，GOS）评分优良22例，中残4例，重残1例，植物生存状态1例。结论：对于大脑中动脉分叉处动脉瘤，应及早手术，术前影像学上的准确分析与评估、合适的手术入路、娴熟的手术技巧是有效夹闭大脑中动脉分叉处动脉瘤，提高术后疗效的关键。

Abstract:

Objective：To summarize the clinical curative effect and experiences in the microsurgical treatment for middle cerebral artery bifurcation aneurysms（MbifAs）. Methods：The clinical data and operation process of 28 patients underwent microsurgery surgi－cal treatment for middle cerebral artery bifurcation aneurysm were retrospectively analyzed. Results：Thirty MbifAs were found in 28 patients including 5 patients with complicated intracranial hematoma. Preoperative computed tomography angiography or digital sub－traction angiography was performed to evaluate the form and size of aneurysms and its relationship with bifurcate of blood vessels. Microsurgery was carefully designed for all patients. All patients were followed up for 6 months to 1 year. According to glasgow outcome scale of 28 patients，22 were recovered well，4 moderately disabled，1 severely disabled，1 vegetatively survived. Conclusion：Early surgery is necessary for middle cerebral artery bifurcation aneurysms. Accurate preoperative imaging analysis and evaluation，appropri－ate surgical approach，skilled operation skills to clip aneurysm are the keys to improve the prognosis of surgery.