CAJ | 학술논문

目的验证经翼点入路显微手术治疗颅内前循环动脉瘤的效果,探讨该术式的手术并发症.方法南京医科大学附属常州第二人民医院阳湖院区神经外科自2002年1月至2012年1月经翼点入路显微手术治疗颅内前循环动脉瘤患者61例,分析总结患者的疗效和并发症.结果本组患者中60个动脉瘤行夹闭术,3个行动脉瘤包裹术.61例患者中50例(81.97％)恢复良好;5例术后出现对侧偏瘫;4例出现癫痫;1例植物性生存;1例死亡.38例术后行DSA检查,14例行CTA检查,显示动脉瘤均消失,载瘤动脉恢复畅通;术后1～12月进行复查,7例出现精神障碍,8例术侧出现颞肌萎缩,3例患者出现脑积水,行脑室-腹腔分流术后痊愈;7例形成下肢静脉血栓,行积极抗凝治疗后痊愈;5例出现动脉眼神经麻痹症状,6～12个月后均恢复良好;2例因损伤眶上神经出现眼睑下垂;此外1例患者出现颅内感染,1例出现脑梗死.结论显微直视下切除或夹闭动脉瘤是治疗颅内前循环动脉瘤的一项有效方法,早期进行动脉瘤夹闭术可以减少并发症的发生.
목적 험증경익점입로현미수술치료로내전순배동맥류적효과,탐토해술식적수술병발증.방법 남경의과대학부속상주제이인민의원양호원구신경외과자2002년1월지2012년1월경익점입로현미수술치료로내전순배동맥류환자61례,분석총결환자적료효화병발증.결과 본조환자중60개동맥류행협폐술,3개행동맥류포과술.61례환자중50례(81.97％)회복량호;5례술후출현대측편탄;4례출현전간;1례식물성생존;1례사망.38례술후행DSA검사,14례행CTA검사,현시동맥류균소실,재류동맥회복창통;술후1～12월진행복사,7례출현정신장애,8례술측출현섭기위축,3례환자출현뇌적수,행뇌실-복강분류술후전유;7례형성하지정맥혈전,행적겁항응치료후전유;5례출현동맥안신경마비증상,6～12개월후균회복량호;2례인손상광상신경출현안검하수;차외1례환자출현로내감염,1례출현뇌경사.결론 현미직시하절제혹협폐동맥류시치료로내전순배동맥류적일항유효방법,조기진행동맥류협폐술가이감소병발증적발생.
Objective To explore the efficacy and complications of microsurgical treatment of anterior circulation aneurysms via pterional approach.Methods The clinical data of 61 patients with intracranial aneurysms,diagnosed in our hospital from January 2002 to January 2012,were collected; their outcomes and complications were analyzed.Results Clipping was performed in 60 arterial aneurysms and bundling in 3 aneurysms.Fifty patients (81.97％) got good recovery accompanied by 5 having postoperative contralateral hemiplegia,4 epilepsy,1 vegetative state and 1 death.The DSA of 38 aneurysms and CTA of 14 aneurysms after the surgery confirmed that the aneurysms disappeared and the parent arteries restored patency.The postsurgical review (1-12 months after the surgery) showed that 7 patients had mental disorders,8 had temporalis muscle atrophy,and 3 had hydrocephalus and ventriculo-peritoneal shunt was performed.Seven patients formed deep vein thrombosis cured after anticoagulant therapy.Five patients had arterial nerve paralysis,being good recovery after 6-12 months.Two patients had ptosis.One had intracranial infection and 1 cerebral infarction.Conclusion Excision or clipping the intracranial anterior aneurysms under direct vision by microscopy technique is an effective way; early surgery can reduce the incidence of complications.