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目的探讨经眶上锁孔显微外科手术治疗Hunt-Hess Ⅰ～Ⅱ级前交通动脉瘤的可行性、手术时机、手术技巧及疗效。方法回顾性分析我院2009年2月～2011年11月经眶上锁孔入路行显微外科手术治疗的65例Hunt-Hess Ⅰ～Ⅱ级前交通动脉瘤患者的治疗情况。结果手术夹闭动脉瘤65例,行夹闭加包裹9例,术后再出血1例,无致残、无死亡病例。结论眶上锁孔入路适合治疗Hunt-Hess Ⅰ～Ⅱ级前交通动脉瘤,内镜辅助对于瘤颈显露及穿支血管保护作用较大,术中吲哚青绿荧光造影有助于判断瘤颈有无残留,手术并发症少,手术应在出血后3 d内。
Objective To investigate the feasibility, timing, technique and efficacy of supraorbital keyhole microsurgery in the treatment of Hunt-Hess Ⅰ ~ Ⅱ grade anterior communicating aneurysms. Methods The clinical data of 65 patients with Hunt-Hess Ⅰ-Ⅱ anterior communicating artery aneurysm treated by microsurgical supraorbital keyhole approach from February 2009 to November 2011 in our hospital were retrospectively analyzed. Results Surgical closure of aneurysm in 65 cases, 9 cases of clipping and wrapping, postoperative bleeding in 1 case, no disability, no deaths. Conclusions The supraorbital keyhole approach is suitable for the treatment of Hunt-Hess grade Ⅰ ~ Ⅱ anterior communicating aneurysms. The endoscopic assist has great protective effect on the neoplasia of the neck and perforating branches. Intraoperative indocyanine green fluorescence imaging is helpful to judge the tumor neck Whether there is residue, less surgical complications, surgery should be within 3 days after bleeding.