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1、·1214·南方医科大学学报(JSouthMedUniv)2012;32(8)临床研究颅内巨大动脉瘤的手术治疗122黄理金,冯文峰,漆松涛12南方医科大学第三附属医院神经外科、介入科,广东广州,510630;南方医院神经外科,广东广州510515摘要:目的探讨颅内巨大动脉瘤的手术时机、手术方法及疗效。方法回顾性分析2001年1月~2010年1月南方医院神经外科治疗的15例颅内巨大动脉瘤。动脉瘤夹夹闭8例;动脉瘤孤立并颅内-颅外血管架桥术1例;大隐静脉移植颅内-颅外血管架桥并载瘤动脉闭塞3例;瘤体切除,瘤壁缝合1例;单纯孤立2例。结果死亡2例(13%)。其余13例经半年的
2、随访,好12例(80%),差1例(7%)。结论巨大动脉瘤手术设计应个体化,术者应是具备血管重建能力的有经验的显微神经外科医师。关键词:巨大动脉瘤;显微手术;疗效中图分类号:R651.1文献标志码:A文章编号:1673-4254(2012)08-1214-04doi:10.3969/j.issn.1673-4254.2012.08.33http://www.cnki.net/kcms/detail/44.1627.R.20120716.1023.009.htmlMicrosurgicalmanagementofintracranialgiantaneurysmsHUANG
3、Lijin1,FENGWenfeng2,QISongtao21DepartmentofNeurosurgeryandInterventionalRadiology,ThirdAffiliatedHospitalofSouthernMedicalUniversity,Guangzhou510630,China;2DepartmentofNeurosurgery,NanfangHospital,SouthernMedicalUniversity,Guangzhou510515,ChinaAbstract:ObjectiveTostudythesurgicaltiming,s
4、trategyandoutcomeofintracranialgiantaneurysms.MethodsTheclinicalandsurgicaldataof15casesofintracranialgiantaneurysmstreatedbetweenJanuary,2001andJanuary,2010wereanalyzed.Aneurysmclippingwasperformedin8cases,aneurysmtrappingwithextracranial-intracranial(EC-IC)bypassin1case,parentarteryocc
5、lusionwithEC-ICbypassusinggreatsaphenousveingraftin3cases,aneurysmresectionwithaneurysmwallsuturein1case,andexclusiveaneurysmtrappingin2cases.ResultsDeathsoccurredin2(13%)ofthecases.Goodsurgicaloutcomeswereachievedin12cases(80%),andpooroutcomewasfoundin1case(7%)afterthesurgery.Conclusion
6、Individualizedsurgicalplanningissuggestedformicrosurgicalmanagementofintracranialgiantaneurysms,andtheoperationshouldbeperformedbysurgeonshavingsufficientmicrosurgicalexperienceandcapableofvesselreconstruction.Keywords:intracranialgiantaneurysms;microsurgery;outcome通常将最大外径超过2.5cm的颅内动脉瘤称为
7、巨网膜下腔出血4例,按Hunt和Hess分级Ⅱ级1例,Ⅲ级2[1]大动脉瘤,其发生率约占所有颅内动脉瘤的5%。由于例,Ⅳ级1例;脑缺血1例;神经系统压迫症状12例;梗巨大动脉瘤显著的占位效应,使手术空间狭小,分离和阻性脑积水2例。根据部位分类:颈内动脉海绵窦段2显露困难,加上动脉瘤颈宽,瘤体易破裂出血,以及邻近例,颈内动脉床突旁段3例,颈内动脉分叉部2例,大脑甚至是瘤体上重要穿支血管的存在,使手术治疗十分困中动脉3例(其中2例为蛇行动脉瘤),前交通动脉3例,难,死亡率、致残率高,是动脉瘤治疗的难点。现将南方椎基底动脉2例。医院神经外科自2