摘要
目的探讨显微外科手术处理大脑中动脉瘤(MCAA)的临床经验。方法回顾性分析2004-2008年行显微手术治疗的35例MCAA患者的临床资料,其中男20例,女15例,年龄18～72岁,平均40岁。35例中22例曾有蛛网膜下隙出血,11例伴颅内血肿,1例伴硬膜下血肿;动脉瘤发生部位:MCA主干10例,分叉部20例,远端5例,其中1例分叉部有两个动脉瘤;左侧13例,右侧22例;巨型7例,大型11例,小型17例。35例均采用显微手术治疗,根据动脉瘤的位置而采取不同的手术入路,其中3例伴有颅内巨大血肿经颞上回入路行手术,1例巨大动脉瘤行左颞浅动脉大脑中动脉吻合术后行载瘤动脉阻断术,1例巨大动脉瘤行动脉瘤孤立、大隐静脉大脑中动脉架桥术。结果巨型及大型MCAA占总例数的51.4%。与术前相比较,35例患者中术后症状好转20例,无变化12例,出现术后并发症3例,无一例死亡。结论MCAA易形成巨大动脉瘤;正确的手术入路及熟练的操作技术有助于提高手术效果。
Objective To summarize the experiences of microsurgery for treatment of middle cerebral artery aneurysms （MCAA）. Methods The clinical data of 35 patients with MCAA treated by microsurgery in General Hospital of PLA from 2004 to 2008 were retrospectively reviewed. Of them there were 20 males and 15 females, aged 18 to 72 years with a mean of 40 years. Of the 35 patients, subarachnoid hemorrhage occurred formerly in 22, intracerebral hemorrhage occurred in 11 and subdural hematoma in one patient. The MCAA located in the middle cerebral artery trunk in 10 patients, at the bifurcation in 20 patients （including one patient with 2 MCAAs）, and in the distal segment in 5 patients. MCAA located on the left side in 13 and on right side in 22 patients. There were 7 patients with giant aneurysms, 11 with large aneurysms and 17 with small aneurysms. Microneurosurgery was performed in all cases, and different approaches were taken according to the locations of aneurysms. Superior temporal gyrus approach was conducted in 3 patients with giant intracerebral hematoma. Bypass of superficial temporal artery to middle cerebral artery was performed before occlusion of the afferent artery in one patient with giant aneurysm. Bypass with saphenous vein to middle cerebral artery was performed in another patient with giant aneurysm. Results The giant and large MCAAs consisted of 51.4% of all cases. Excellent outcomes were achieved in 20 patients, no marked change in 12 patients, and post-operative complications were observed in 3 patients. No perioperative death occurred. Conclusions Giant and large aneurysms are more common in middle cerebral artery aneurysms. Proper surgical approaches based on different situations during operation should be considered to achieve satisfactory outcome.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2010年第3期323-325,共3页
Medical Journal of Chinese People's Liberation Army
关键词
颅内动脉瘤
大脑中动脉
显微外科手术
intracranial aneurysm
middle cerebral artery
microsurgery
