Background:The Middle cerebral artery (MCA) aneurysm is a common type of craniocerebral aneurysm that is prone to rupture and high mortality. The classic surgical approaches are the Pterional approach and the Lateral ...Background:The Middle cerebral artery (MCA) aneurysm is a common type of craniocerebral aneurysm that is prone to rupture and high mortality. The classic surgical approaches are the Pterional approach and the Lateral Supraorbital (LSO) approach, but there are shortcomings. Methods:This study retrospectively analyzed clinical and imaging data from 181 patients with MCA aneurysm clipping in the Department of Neurosurgery, First Affiliated Hospital of Soochow University between 2011 and 2017. Statistical analysis using parametric and nonparametric tests showed that P values below 0.05 were considered statistically significant. Results: The preoperative GCS score (P=0.003), Hunt-Hess scale (P < 0.001) and the operating habits of the surgeon (P < 0.001) affected the surgeon to choose a surgical approach. The choice of two surgical methods on the operation time (P < 0.001), skin incision (P < 0.001), complications (P=0.026), tracheotomy (P=0.014), prognosis (P=0.002) were significantly different. Different surgical approaches (P=0.002), Hunt-Hess scale (P <0.001), GCS scale (P < 0.001), GCS sorse (P < 0.001), skin incision (P=0.031) and complications (P < 0.001) are closely related to the prognosis of patients. Conclusions: Modified LSO approach provides another surgical approach for MCA aneurysm clipping, while avoiding the drawbacks of the LSO approach in the clipping of MCA distal aneurysm.展开更多
目的：探讨大脑中动脉瘤（MCAA）临床特点、影像学特征及显微手术治疗方法及预后。方法回顾性分析51例M C A动脉瘤的临床特点、影像学特征、手术方法及预后。结果动脉瘤夹闭43例，夹闭加包裹4例，包裹加固3例，孤立1例。随访3～12月，按...目的：探讨大脑中动脉瘤（MCAA）临床特点、影像学特征及显微手术治疗方法及预后。方法回顾性分析51例M C A动脉瘤的临床特点、影像学特征、手术方法及预后。结果动脉瘤夹闭43例，夹闭加包裹4例，包裹加固3例，孤立1例。随访3～12月，按照GOS评分，其中5分29例，4分11例，3分4例，2分2例，1分5例。预后较差者（重残至死亡）主要为Hunt-HessⅣ、Ⅴ级者。结论及早而准确诊断动脉瘤，熟练掌握手术时机及显微操作技术能够提高颅内动脉瘤疗效，针对不同的病情采用不同的手术方法与策略，术中保护MCA及保持周围相关血管的通畅是手术的关键。展开更多
目的探讨显微手术治疗破裂大脑中动脉动脉瘤(MCAA)的适应证、术前评估及手术技巧。方法回顾性分析2008年1月-2011年1月经翼点入路行显微外科手术治疗的65例破裂MCAA患者的临床资料。其中男40例,女25例;年龄22～78岁,平均46.8岁。术前Hun...目的探讨显微手术治疗破裂大脑中动脉动脉瘤(MCAA)的适应证、术前评估及手术技巧。方法回顾性分析2008年1月-2011年1月经翼点入路行显微外科手术治疗的65例破裂MCAA患者的临床资料。其中男40例,女25例;年龄22～78岁,平均46.8岁。术前Hunt-Hess分级:Ⅰ级15例,Ⅱ级25例,Ⅲ级13例,Ⅳ级10例,Ⅴ级2例。动脉瘤直径<5 mm 10个,5～15 mm 36个,15～25 mm 15个,>25 mm 4个,平均7.8 mm。其中56例动脉瘤位于大脑中动脉分叉部,5例位于大脑中动脉的M1段,4例位于分叉后M2段。结果手术夹闭动脉瘤60例,余5例行动脉瘤夹闭加包裹术。患者术后获随访3～36个月,平均16个月,均无动脉瘤复发或再出血发生。按格拉斯哥预后评分(GOS)结果评定:恢复良好58例(GOS 4～5分),差5例(GOS 2～3分),死亡2例(GOS 1分)。结论充分的术前评估,合适的手术入路选择,以及手术技巧的灵活应用是显微外科手术成功治疗破裂MCAA的保证。展开更多
文摘Background:The Middle cerebral artery (MCA) aneurysm is a common type of craniocerebral aneurysm that is prone to rupture and high mortality. The classic surgical approaches are the Pterional approach and the Lateral Supraorbital (LSO) approach, but there are shortcomings. Methods:This study retrospectively analyzed clinical and imaging data from 181 patients with MCA aneurysm clipping in the Department of Neurosurgery, First Affiliated Hospital of Soochow University between 2011 and 2017. Statistical analysis using parametric and nonparametric tests showed that P values below 0.05 were considered statistically significant. Results: The preoperative GCS score (P=0.003), Hunt-Hess scale (P < 0.001) and the operating habits of the surgeon (P < 0.001) affected the surgeon to choose a surgical approach. The choice of two surgical methods on the operation time (P < 0.001), skin incision (P < 0.001), complications (P=0.026), tracheotomy (P=0.014), prognosis (P=0.002) were significantly different. Different surgical approaches (P=0.002), Hunt-Hess scale (P <0.001), GCS scale (P < 0.001), GCS sorse (P < 0.001), skin incision (P=0.031) and complications (P < 0.001) are closely related to the prognosis of patients. Conclusions: Modified LSO approach provides another surgical approach for MCA aneurysm clipping, while avoiding the drawbacks of the LSO approach in the clipping of MCA distal aneurysm.
文摘目的：探讨大脑中动脉瘤（MCAA）临床特点、影像学特征及显微手术治疗方法及预后。方法回顾性分析51例M C A动脉瘤的临床特点、影像学特征、手术方法及预后。结果动脉瘤夹闭43例，夹闭加包裹4例，包裹加固3例，孤立1例。随访3～12月，按照GOS评分，其中5分29例，4分11例，3分4例，2分2例，1分5例。预后较差者（重残至死亡）主要为Hunt-HessⅣ、Ⅴ级者。结论及早而准确诊断动脉瘤，熟练掌握手术时机及显微操作技术能够提高颅内动脉瘤疗效，针对不同的病情采用不同的手术方法与策略，术中保护MCA及保持周围相关血管的通畅是手术的关键。
文摘目的探讨显微手术治疗破裂大脑中动脉动脉瘤(MCAA)的适应证、术前评估及手术技巧。方法回顾性分析2008年1月-2011年1月经翼点入路行显微外科手术治疗的65例破裂MCAA患者的临床资料。其中男40例,女25例;年龄22～78岁,平均46.8岁。术前Hunt-Hess分级:Ⅰ级15例,Ⅱ级25例,Ⅲ级13例,Ⅳ级10例,Ⅴ级2例。动脉瘤直径<5 mm 10个,5～15 mm 36个,15～25 mm 15个,>25 mm 4个,平均7.8 mm。其中56例动脉瘤位于大脑中动脉分叉部,5例位于大脑中动脉的M1段,4例位于分叉后M2段。结果手术夹闭动脉瘤60例,余5例行动脉瘤夹闭加包裹术。患者术后获随访3～36个月,平均16个月,均无动脉瘤复发或再出血发生。按格拉斯哥预后评分(GOS)结果评定:恢复良好58例(GOS 4～5分),差5例(GOS 2～3分),死亡2例(GOS 1分)。结论充分的术前评估,合适的手术入路选择,以及手术技巧的灵活应用是显微外科手术成功治疗破裂MCAA的保证。
