摘要：

目的 探讨经双侧额外侧入路显微手术同期处理颅内镜像动脉瘤的手术方法、临床效果及手术并发症。方法 回顾分析18 例前循环镜像动脉瘤患者的临床资料，均经双侧额外侧入路同期行动脉瘤夹闭术，Glasgow 预后分级（GOS）评价手术疗效。结果 18 例患者共发现36 个动脉瘤，其中后交通动脉镜像动脉瘤9 例（18 个）、大脑中动脉镜像动脉瘤9 例（18 个）。术后GOS 评分5 分16 例、4 分2 例，术后并发症包括交通性脑积水（1 例）和肺部感染（1 例），无死亡患者。术后6 个月CTA 显示动脉瘤夹闭完全、未复发，载瘤动脉血流通畅。结论 采用经双侧额外侧入路同期夹闭颅内镜像动脉瘤手术创伤小、术野合理、安全性高、手术疗效满意、预后良好，是微侵袭神经外科手术的新尝试。

关键词: 颅内动脉瘤, 额叶, 显微外科手术

Abstract:

Objective  To investigate surgical strategies, clinical effects and complications of microsurgical one-stage treatment of intracranial mirror aneurysms via bilateral frontolateral approaches.  Methods  Review clinical data of 18 cases with anterior circulation mirror aneurysms who underwent one-stage clipping via bilateral frontolateral approaches from July 2010 to July 2015 admitted to Department of Neurosurgery in Tianjin Huanhu Hospital. The operative efficacy was evaluated according to postoperative Glasgow Outcome Scale (GOS).  Results  The 36 aneurysms in 18 patients were successfully clipped via bilateral frontolateral approaches at one-stage, including 18 posterior communicating artery (PCoA) mirror aneurysms in 9 cases and 18 middle cerebral artery (MCA) mirror aneurysms in 9 cases. GOS score of 5 was discovered in 16 cases, and 4 was discovered in 2 cases after operation. One case underwent ventriculoperitoneal shunting (VPS) due to communicating hydrocephalus, one case got postoperative pulmonary infection and no death occurred. Intracranial CTA at 6 months postoperatively showed aneurysms of 18 patients were clipped completely, the parent artery blood flow was smooth, and no recurrence was found.  Conclusions  Microsurgical one-stage clipping via bilateral frontolateral approaches for treating intracranial mirror aneurysms is a sugrical method with small incision, fitting surgical field, high safety, satisfactory effect and good prognosis, which is a new minimally invasive neurosurgical technique.

Key words: Intracranial aneurysm, Frontal lobe, Microsurgery