翼点入路联合部分眶顶和额骨颧突切除治疗前交通动脉破裂动脉瘤的效果分析

发布时间：2018-02-07 09:24

本文关键词： 颅内动脉瘤蛛网膜下腔出血眶翼点入路认知障碍　出处：《中国脑血管病杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的探讨采用翼点入路联合部分眶顶和额骨颧突切除(改良眶翼点入路)处理前交通动脉破裂动脉瘤的效果。方法回顾性连续纳入2013年10月至2016年10月滨州医学院附属医院神经外科收治的前交通动脉破裂动脉瘤36例,均经DSA或CT血管成像检查证实。对标准眶翼点入路的6次切割成型进行简化,采用眶翼点入路但仅去除部分眶顶而未去除眶外侧壁、蝶骨翼等骨性结构,总结前交通动脉破裂动脉瘤的临床表现、影像学资料、手术方式及手术结果。结果治疗36例前交通动脉破裂动脉瘤均采用改良眶翼点入路,术后CT复查未见明显的脑组织牵拉性损伤,出院时格拉斯哥预后评分5分25例,4分8例,3分3例,无死亡病例。随访3~24个月无再出血及复发病例。未发生眼球凹陷、眼球损伤及颅神经损伤等并发症。结论改良眶翼点入路通过切除部分眶顶和额骨颧突增加了手术操作空间,避免牵拉脑组织,明显缩短了手术操作距离,增大了对深部的观察角度,适用于处理前交通动脉动脉瘤,尤其后指向、上指向及高位前交通动脉动脉瘤。术中无骨质丢失,无需行眶顶重建;从解剖上保留了额叶直回,有利于保护术后患者认知功能。
[Abstract]:Objective to investigate the effect of pterional approach combined with partial zygomaticoidectomy (modified orbital pterygoid approach) for the treatment of ruptured aneurysms of anterior communicating artery. Methods Binzhou Medicine from October 2013 to October 2016 was included retrospectively. 36 cases of ruptured anterior communicating artery aneurysms were treated in neurosurgery department of affiliated hospital. All of them were confirmed by DSA or CT angiography. The standard orbital pterional approach was simplified for 6 times. The orbital pterional approach was adopted, but only part of the orbital apex was removed without removing the lateral wall of the orbit and the sphenoid pterygoid. Results 36 cases of ruptured aneurysms of anterior communicating artery were treated by modified orbital pterional approach. There was no obvious brain tissue traction injury on CT. Glasgow prognostic score was 5 in 25, 4 in 8, 3 in 3. There were no cases of rebleeding or recurrence after 3 ~ 24 months follow-up. No eyeball depression was found. Conclusion the modified orbital pterional approach increases the operative space by removing part of the orbital roof and the zygomatic process of the frontal bone, avoids pulling the brain tissue, and shortens the operating distance. It is suitable for the treatment of the anterior communicating artery aneurysms, especially the posterior, upward and high anterior communicating artery aneurysms. There is no bone loss during the operation, no orbital reconstruction is required, and the frontal lobe straight gyrus is anatomically preserved. It is beneficial to protect the cognitive function of postoperative patients.
【作者单位】：滨州医学院附属医院神经外科;
【分类号】：R651.12

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