摘要
目的探讨硬性内镜在颅内动脉瘤手术中的应用，分析其优缺点。方法回顾性分析63例患者66个动脉瘤的显微手术，其中63个破裂动脉瘤，3个未破裂动脉瘤。多数患者在内镜辅助下完成动脉瘤夹闭术，包括动脉瘤夹闭前后对载瘤动脉、瘤颈及瘤周穿通支的观察，以确定最佳夹闭位置和程度。结果内镜能更好地观察瘤周局部解剖结构，保证首次最佳夹闭，5例第一次夹闭后，经内镜发现夹闭不佳而重新调整动脉瘤夹，其中1例颈内后交通动脉瘤夹闭不全；1例颈内动脉眼动脉瘤夹闭不全；1例颈内后交通动脉瘤夹闭动脉瘤同时夹闭后交通动脉；2例前交通动脉瘤夹闭穿通支。在使用内镜过程中造成1例轻度颞叶脑挫伤，在所有过程中未造成动脉瘤破裂出血。结论在颅内动脉瘤夹闭过程中辅助使用内镜，能更好地观察动脉瘤及其周围的局部解剖结构，提高动脉瘤夹闭手术的质量。
Objective To evaluate the usefulness of endoscope in the microsurgical treatment of intracranial aneurysms and analyze its benefits , risksand disadvantages. Mehtods We retrospectively study 63 patients with 66 aneurysms, treated between Janurary 2007 and October 2007, for whom the endoscope were used to assist the microsurgical treatment of lesions. 63 aneurysms were ruptured. In most of the eases, the endoscope was used in addition to microsurgical dissection and clipping （before, during and after clipping）. Observation of the anatomic features of necks, perforators and selection of optimal clip position were performed. Results In the majority of cases, the endoscope was used. The clip was repositioned in five aneurysm operations, including incomplete neck obliteration in 1 case of intracarotid - ophathalmic aneurysm, incomplete neck obliteration in 1 [CA -PCoA aneurysms, involvement of perforating vessels with the clip in 1 ICA - PCoA aneurysms, involvement of perforating vessels with the clip in 2 ACoA aneurysms. One patient experienced a mild temporal lobe contusion during the application of endoscope. There was no intra- operative aneurysm rupture due to endoscope manipulation. Conclusions Endoscope is vary useful during cerebral aneurysm surgery. It can provide valuable information for the assessment of regional anatomic features around aneurysm and improve the quality of aneurysm surgery.
出处
《中华神经外科杂志》
CSCD
北大核心
2010年第4期350-352,共3页
Chinese Journal of Neurosurgery
