论文部分内容阅读
目的探讨一侧入路显露并夹闭对侧后交通动脉瘤的可行性。方法对15具国人成年尸头标本经甲醛固定,采用显微解剖技术,经一侧入路显露和观察对侧后交通动脉起始部及其毗邻关系,以探求最佳显露途径,并回顾性分析1997年-2002年收治的9例包含后交通动脉瘤在内的双侧颅内多发动脉瘤患者的治疗结果。结果在15具尸头的30支后交通动脉中,对侧后交通动脉起始部成功显露15支(50%),后交通动脉起源于颈内动脉后外侧壁者16支(53.3%),后壁者6支(20.0%),后内侧壁者8支(26.7%)。后交通动脉起点至颈内动脉穿出硬脑膜的距离为(8.74±2.57)mm,后交通动脉主干直径为(1.67±0.39)mm,通常在视交叉前间隙内,轻轻向外牵拉对侧视神经,即可显露后交通动脉起始点内侧面。1具标本须经过视交叉上外侧,在对侧视神经-颈内动脉间隙内,轻轻向外牵拉颈内动脉才能显露对侧后交通动脉及其起始部。在视交叉前间隙,经过对侧视神经下方探查该部位是较理想的途径,切开对侧硬脑膜镰状韧带,避免损伤视神经至关重要。9例经手术夹闭的双侧颅内多发动脉瘤患者,经一侧翼点入路显露并夹闭对侧后交通动脉瘤者3例。结论严格选择的双侧颅内多发动脉瘤患者,经一侧入路显露并夹闭对侧后交通动脉瘤是可行、安全和有效的。
Objective To explore the feasibility of one-side approach to expose and clamp the contralateral posterior communicating artery aneurysm. Methods Fifteen adult cadaver heads were fixed with formalin. Microsurgical anatomical technique was used to reveal and observe the origin of the contralateral posterior communicating artery and its adjacencies via the one-sided approach to find out the best way of revealing and retrospectively Nine patients with bilateral multiple intracranial aneurysms including posterior communicating artery aneurysms treated from 1997 to 2002 were analyzed. Results Of the 15 posterior communicating arteries in 15 cadaveric heads, 15 (50%) were successfully revealed at the beginning of the contralateral posterior communicating artery and 16 (53.3%) at the posterior communicating artery originated from the posterior lateral wall of the internal carotid artery. Six posterior wall (20.0%), posterior medial wall of eight (26.7%). The distance from the posterior communicating artery to the carotid artery penetrating the dura was (8.74 ± 2.57) mm, and the diameter of the posterior communicating artery was (1.67 ± 0.39) mm. The anterior communicating artery was usually gently pulled outward in the anterior segment of the optic chiasm Side of the optic nerve, you can reveal the starting point of the posterior communicating artery inside. A specimen to be through the optic chiasm on the outside, in the contralateral optic nerve - internal carotid artery space, gently pull the internal carotid artery in order to reveal the contralateral posterior communicating artery and its beginning. In the anterior segment of the optic chiasm, exploration of this area under the contralateral optic nerve is an ideal route to incise the contralateral dura mater to prevent the optic nerve from being damaged. Nine patients with bilateral intracranial aneurysm were surgically occluded. Three patients with contralateral posterior communicating aneurysm were revealed and occluded via the pterional approach. Conclusions Strictly selected patients with bilateral intracranial multiple aneurysms are feasible, safe and effective in exposing and clamping the contralateral posterior communicating artery aneurysm on one side.