摘要
目的 探讨经眶上眉弓锁孔人路微创手术夹闭基底动脉远端动脉瘤的可行性及其疗效.方法 2006至2011年苏州大学附属第二医院基底动脉远端动脉瘤患者12例,均因蛛网膜下腔出血入院.2例于出血24h内急诊手术,7例在出血后3～14 d手术;3例于出血2周后手术.动脉瘤位于BA（基底动脉）10例,P（大脑后动脉）1～2段及P2段动脉瘤各1例.其中2例BA分叉部动脉瘤分别合并大脑前动脉A1段动脉瘤及大脑中动脉多发动脉瘤,于手术中一期夹闭.术中磨除前床突、后床突各2例,离断后交通动脉1例,以扩大操作空间;1例术前于BA中置人球囊导管,以备术中出血时控制载瘤动脉近端.结果 12例基底动脉远端动脉瘤均完全夹闭,3枚多发性动脉瘤也在同一眶上眉弓锁孔入路下一期夹闭.手术中有1例动脉瘤术中破裂出血,经载瘤动脉临时控制后,完好夹闭动脉瘤.术后患者均神志清醒,无肢体活动障碍等残疾.结论 眶上眉弓锁孔入路下,磨除前床突或后床突骨质,可增加对基底动脉远端动脉瘤夹闭操作的空间;对于基底动脉分叉部动脉瘤的高度在前颅底水平1.5 cm以内者,经眶上眉弓锁孔手术入路夹闭安全、有效.
Objective To explore the feasibility and efficacy of supraorbital keyhole approach （SOKA） for the clipping of distal basilar artery （BA） aneurysms.Methods A total of 12 patients with distal BA aneurysms were treated with SOKA.All patients had subarachnoid hemorrhage （SAH）.They underwent surgeries for an average of 7.6 days post-SAH （n =2,within 24 hours; n =7,3-14 days; n =2,2 week later）.Aneurysms were located on BA （n =10）,posterior cerebral artery （PCA） 1-2 segment （n =1） and PCA 2 segment （n =1）.One-stage operations were performed in 2 cases with BA bifurcation aneurysm accompanied with anterior cerebral artery （ACA） 1 segment aneurysm and multiple middle cerebral artery （MCA） aneurysms respectively.Anterior and posterior clinoid process was drilled off in 2 patients respectively to increase the room for maneuver.Posterior communicating artery was cut in one case to expand the working space.Once a balloon catheter was put into BA,proximal artery control was implemented if immature aneurysm rupture occurred.Results All distal BA aneurysms were completely clipped; 3 accompanied aneurysms were clipped together through single supraorbital keyhole approach.One aneurysm ruptured intra-operatively and was clipped successfully with temporary parent arterial occlusion.No conscious disturbance and dyskinesia occurred post-operatively for all patients.Conclusion During the procedure of SOKA,anterior and posterior clinoidectomy may be applied to increase the working space.Distal BA aneurysms located less than 15 mm higher over anterior skull base can be effectively treated via SOKA.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第9期672-675,共4页
National Medical Journal of China
基金
江苏省临床医学科技专项基金（BL2012048）
江苏省创新团队与领军人才基金（LJ201150）
关键词
颅内动脉瘤
基底动脉动脉瘤
显微手术
锁孔入路
Intracranial aneurysm
Basilar artery aneurysm
Microsurgery
Keyhole approach
