顯微手術治療破裂大腦中動脈動脈瘤_《華西醫學》

作者：

毛珂 , 李進 , 賀民 ,  游潮

四川大學華西醫院神經外科（成都，610041）;

關鍵詞：

大腦中動脈動脈瘤翼點入路顯微外科

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目的　探討顯微手術治療破裂大腦中動脈動脈瘤（MCAA）的適應證、術前評估及手術技巧。方法　回顧性分析2008年1月－2011年1月經翼點入路行顯微外科手術治療的65例破裂MCAA患者的臨床資料。其中男40例，女25例；年齡22～78歲，平均46.8歲。術前Hunt-Hess分級：Ⅰ級15例，Ⅱ級25例，Ⅲ級13例，Ⅳ級10例，Ⅴ級2例。動脈瘤直徑＜5 mm 10個，5～15 mm 36個，15～25 mm 15個，＞25 mm 4個，平均7.8 mm。其中56例動脈瘤位于大腦中動脈分叉部，5例位于大腦中動脈的M1段，4例位于分叉后M2段。結果　手術夾閉動脈瘤60例，余5例行動脈瘤夾閉加包裹術。患者術后獲隨訪3～36個月，平均16個月，均無動脈瘤復發或再出血發生。按格拉斯哥預后評分（GOS）結果評定：恢復良好58例（GOS 4～5分），差5例（GOS 2～3分），死亡2例（GOS 1分）。結論　充分的術前評估，合適的手術入路選擇，以及手術技巧的靈活應用是顯微外科手術成功治療破裂MCAA的保證。

引用本文： 毛珂,李進,賀民,游潮. 顯微手術治療破裂大腦中動脈動脈瘤. 華西醫學, 2012, 27(5): 673-676. doi: 復制

1.	Rinne J, Shen H, Kiivisaari R, et al. Surgical management of aneurusyms of middle cerebral artery[M]//Schmidick HH, Sweet WH. Operative neurosurgical techniques，indications，methods and results. New York: WB Saunders, 2000: 1159-1180.
2.	Suzuki J, Yoshimoto T, Kayama T, et al. Surgical treatment of middle cerebral artery aneurysms [J]. J Neurosurg， 1984， 61(1): 17-23.
3.	Wanebo JE, Zabramski JM, Spetaler RF. Superficial temporal artery to middle cerebral artery bypass grafting for cerebral revascularization [J]. Neurosurgery, 2004, 55(2): 395-399.
4.	Heros RC, Fritsch MJ. Surgical management of middle cerebral artery aneurysms [J]. Neurosurgery, 2001, 48(4): 780-786.
5.	Ahn JY, Han IB, Joo JY. Aneurysm in the penetrating artery of the distal middle cerebral artery presenting as intracerebral hemorrhage [J]. Acta Neurochir (Wien), 2005, 147(12): 1287-1290.
6.	豐育功, 荊友斌, 張麗云, 等. 三維CT血管造影在顱內動脈瘤診治中的應用[J]．中華神經外科雜志, 2009, 25(11): 996-998．.
7.	Tipper G, U-King-Im JM, Price SJ, et al. Detection and evaluation of intracranial aneurysms with 16-row multislice CT angiography[J]. Clin Radiol, 2005, 60(5): 565-572.
8.	劉翼, 游潮, 賀民, 等. 顱內破裂動脈瘤手術時機的探討(附237例分析)[J]. 中國微侵襲神經外科雜志, 2007, 12(5): 199-201．.
9.	Tawk RG, Pandey A, Levy E, et al. Coiling of ruptured aneurysm followed by evacuation of hematoma[J]. World Neurosurg, 2010, 74(6): 626-631.
10.	Dashti R, Hernesniemi J, Niemelä M, et al. Microneurosurgical management of middle cerebral artery bifurcation aneurysms[J]. Surg Neurol, 2007, 67(5): 441-456.
11.	Kazumata K, Kamiyama H, Yokoyama Y, et al. Poor-grade ruptured middle cerebral artery aneurysm with intracerebral hematoma: bleeding characteristics and management[J]. Neurol Med Chir (Tokyo), 2010, 50(10): 884-892.
12.	Morgan MK, Mahattanakul W, Davidson A, et al. Outcome for middle cerebral artery aneurysm surgery[J]. Neurosurgery, 2010, 67(3): 755-761.
13.	陳志, 馮華, 吳南, 等. 術中微血管多普勒超聲在顱內動脈瘤手術中的初步應用[J].中華神經外科雜志, 2005, 43(1): 69-70.
14.	Taki W, Sakai N, Suzuki H, et al. Determinants of poor outcome after aneurysmal subarachnoid hemorrhage when both clipping and coiling are available: Prospective Registry of Subarachnoid Aneurysms Treatment （PRESAT） in Japan[J]. World Neurosurg, 2011, 76(5): 437-445.

1. 　Rinne J, Shen H, Kiivisaari R, et al. Surgical management of aneurusyms of middle cerebral artery[M]//Schmidick HH, Sweet WH. Operative neurosurgical techniques，indications，methods and results. New York: WB Saunders, 2000: 1159-1180.
2. 　Suzuki J, Yoshimoto T, Kayama T, et al. Surgical treatment of middle cerebral artery aneurysms [J]. J Neurosurg， 1984， 61(1): 17-23.
3. 　Wanebo JE, Zabramski JM, Spetaler RF. Superficial temporal artery to middle cerebral artery bypass grafting for cerebral revascularization [J]. Neurosurgery, 2004, 55(2): 395-399.
4. 　Heros RC, Fritsch MJ. Surgical management of middle cerebral artery aneurysms [J]. Neurosurgery, 2001, 48(4): 780-786.
5. 　Ahn JY, Han IB, Joo JY. Aneurysm in the penetrating artery of the distal middle cerebral artery presenting as intracerebral hemorrhage [J]. Acta Neurochir (Wien), 2005, 147(12): 1287-1290.
6. 　豐育功, 荊友斌, 張麗云, 等. 三維CT血管造影在顱內動脈瘤診治中的應用[J]．中華神經外科雜志, 2009, 25(11): 996-998．.
7. 　Tipper G, U-King-Im JM, Price SJ, et al. Detection and evaluation of intracranial aneurysms with 16-row multislice CT angiography[J]. Clin Radiol, 2005, 60(5): 565-572.
8. 　劉翼, 游潮, 賀民, 等. 顱內破裂動脈瘤手術時機的探討(附237例分析)[J]. 中國微侵襲神經外科雜志, 2007, 12(5): 199-201．.
9. 　Tawk RG, Pandey A, Levy E, et al. Coiling of ruptured aneurysm followed by evacuation of hematoma[J]. World Neurosurg, 2010, 74(6): 626-631.
10. 　Dashti R, Hernesniemi J, Niemelä M, et al. Microneurosurgical management of middle cerebral artery bifurcation aneurysms[J]. Surg Neurol, 2007, 67(5): 441-456.
11. 　Kazumata K, Kamiyama H, Yokoyama Y, et al. Poor-grade ruptured middle cerebral artery aneurysm with intracerebral hematoma: bleeding characteristics and management[J]. Neurol Med Chir (Tokyo), 2010, 50(10): 884-892.
12. 　Morgan MK, Mahattanakul W, Davidson A, et al. Outcome for middle cerebral artery aneurysm surgery[J]. Neurosurgery, 2010, 67(3): 755-761.
13. 　陳志, 馮華, 吳南, 等. 術中微血管多普勒超聲在顱內動脈瘤手術中的初步應用[J].中華神經外科雜志, 2005, 43(1): 69-70.
14. 　Taki W, Sakai N, Suzuki H, et al. Determinants of poor outcome after aneurysmal subarachnoid hemorrhage when both clipping and coiling are available: Prospective Registry of Subarachnoid Aneurysms Treatment （PRESAT） in Japan[J]. World Neurosurg, 2011, 76(5): 437-445.

《華西醫學》

顯微手術治療破裂大腦中動脈動脈瘤

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《華西醫學》

顯微手術治療破裂大腦中動脈動脈瘤

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