CAJ | 학술논문

目的探讨大脑中动脉巨大型动脉瘤的手术治疗方法.方法回顾性分析2001年1月至2008年3月17例颅内大脑中动脉巨大型动脉瘤患者的手术方法和疗效.术前采用CT、CTA、MR、MRA、DSA及三维DSA检查,以了解动脉瘤的部位、大小,形状以及侧支代偿情况,制定个体化治疗方案.在手术入路上多采用改良翼点入路,其中行动脉瘤瘤颈直接或塑形夹闭者4例,动脉瘤孤立或孤立后切除4例,动脉瘤切除或孤立后血管重建7例,动脉瘤包裹2例.结果 CT和MRI能清楚地显示动脉瘤的形状、大小.DSA及三维DSA能显示瘤颈以及与附近血管和骨质的关系.根据格拉斯骨预后评分表评分,出院时恢复优良者12例,中度病残4例,重度病残1例,无死亡病例.结论术前有必要进行详细的影像学检查,有助于术者规划手术方法,制定个体化治疗方案,采用不同术式取得良好预后.载瘤动脉暂时性阻断、动脉瘤切开血栓清除均有助于瘤颈夹闭.血管重建技术为大脑中动脉巨大型动脉瘤的手术治疗开辟了新途径,明显改善了手术效果.
목적 탐토대뇌중동맥거대형동맥류적수술치료방법.방법 회고성분석2001년1월지2008년3월17례로내대뇌중동맥거대형동맥류환자적수술방법화료효.술전채용CT、CTA、MR、MRA、DSA급삼유DSA검사,이료해동맥류적부위、대소,형상이급측지대상정황,제정개체화치료방안.재수술입로상다채용개량익점입로,기중행동맥류류경직접혹소형협폐자4례,동맥류고립혹고립후절제4례,동맥류절제혹고립후혈관중건7례,동맥류포과2례.결과 CT화MRI능청초지현시동맥류적형상、대소.DSA급삼유DSA능현시류경이급여부근혈관화골질적관계.근거격랍사골예후평분표평분,출원시회복우량자12례,중도병잔4례,중도병잔1례,무사망병례.결론 술전유필요진행상세적영상학검사,유조우술자규화수술방법,제정개체화치료방안,채용불동술식취득량호예후.재류동맥잠시성조단、동맥류절개혈전청제균유조우류경협폐.혈관중건기술위대뇌중동맥거대형동맥류적수술치료개벽료신도경,명현개선료수술효과.
Objective To discuss the surgical treatment of the giant aneurysms of middle cerebral artery. Methods Clinical data, surgical methods and outcomes were analyzed in 17 giant aneurysms of middle cerebral artery treated from January 2001 to March 2008. CT scan, CTA, MBA, DSA and 3D-DSA were performed before operations so that we could comprehend the location, size, and shape of aneurysms and compensatory circulation of collateral branches to design the individualized treatment options. All patients had been surgically treated mostly by modified pterional approach, of which, direct clipping of the aneurysms was accomplished in 4 patients, aneurysms trapping or removal after trapping in 4, aneurysms excision or trapping combined with vessels reconstruction in 7, and aneurysms wrapping in 2 cases. Results CT and MRI revealed the shape and size of aneurysms clearly, while DSA and 3D-DSA could demonstrate the aneurysm's neck and relationship with the adjacent structure. Postoperative neurological function was evaluated according to Glasgow Outcome Scale when patients were discharged. Twelve patients had excellent neurological outcomes. However 4 patients were moderately disabled and one were severely disabled. No patient was dead postoperatively. Conclusions It is necessary to perform elaborate imaging before operations for individualized surgical planning. The temporary occlusion of the parent artery and elimination of intra-aneurysmal thrombus are helpful to clipping the aneurysmal neck. Vessels reconstruction is a new and effective method of treating the giant aneurysms of middle cerebral artery.