本文關(guān)鍵詞： 顱內(nèi)動(dòng)脈瘤 蛛網(wǎng)膜下腔出血 眶翼點(diǎn)入路 認(rèn)知障礙　出處：《中國(guó)腦血管病雜志》2017年02期 　論文類型：期刊論文

【摘要】：目的探討采用翼點(diǎn)入路聯(lián)合部分眶頂和額骨顴突切除(改良眶翼點(diǎn)入路)處理前交通動(dòng)脈破裂動(dòng)脈瘤的效果。方法回顧性連續(xù)納入2013年10月至2016年10月濱州醫(yī)學(xué)院附屬醫(yī)院神經(jīng)外科收治的前交通動(dòng)脈破裂動(dòng)脈瘤36例,均經(jīng)DSA或CT血管成像檢查證實(shí)。對(duì)標(biāo)準(zhǔn)眶翼點(diǎn)入路的6次切割成型進(jìn)行簡(jiǎn)化,采用眶翼點(diǎn)入路但僅去除部分眶頂而未去除眶外側(cè)壁、蝶骨翼等骨性結(jié)構(gòu),總結(jié)前交通動(dòng)脈破裂動(dòng)脈瘤的臨床表現(xiàn)、影像學(xué)資料、手術(shù)方式及手術(shù)結(jié)果。結(jié)果治療36例前交通動(dòng)脈破裂動(dòng)脈瘤均采用改良眶翼點(diǎn)入路,術(shù)后CT復(fù)查未見明顯的腦組織牽拉性損傷,出院時(shí)格拉斯哥預(yù)后評(píng)分5分25例,4分8例,3分3例,無死亡病例。隨訪3~24個(gè)月無再出血及復(fù)發(fā)病例。未發(fā)生眼球凹陷、眼球損傷及顱神經(jīng)損傷等并發(fā)癥。結(jié)論改良眶翼點(diǎn)入路通過切除部分眶頂和額骨顴突增加了手術(shù)操作空間,避免牽拉腦組織,明顯縮短了手術(shù)操作距離,增大了對(duì)深部的觀察角度,適用于處理前交通動(dòng)脈動(dòng)脈瘤,尤其后指向、上指向及高位前交通動(dòng)脈動(dòng)脈瘤。術(shù)中無骨質(zhì)丟失,無需行眶頂重建;從解剖上保留了額葉直回,有利于保護(hù)術(shù)后患者認(rèn)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.
【作者單位】： 濱州醫(yī)學(xué)院附屬醫(yī)院神經(jīng)外科;
【分類號(hào)】：R651.12

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