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目的 讨论神经内镜在颅内动脉瘤外科的作用 ,分析其价值和缺点。方法 应用神经内镜配合显微镜手术夹闭颅内动脉瘤 88例 (89个动脉瘤 ) ,其中前循环系统动脉瘤 81例 (共 82个动脉瘤 ) ,后循环系统动脉瘤 7例。全部采用微骨孔入路。全部病例在动脉瘤夹闭前、后进行多普勒超声探测。其中神经内镜辅助显微神经外科手术 (EAM ) 84例 ,手术显微镜下夹闭动脉瘤后 ,神经内镜观察动脉瘤蒂结构、供血动脉分支和深部穿通支 ,并证实动脉瘤夹的位置。神经内镜控制显微神经外科手术 (ECM) 5例 ,在内镜下可清楚观察动脉瘤周围的解剖 ,观察到颈内动脉后方的后交通动脉、对侧前动脉。结果 86例术后 2周复查数字减影血管造影 (DSA) ,均显示动脉瘤夹闭满意。无手术死亡 ,手术后并发症 7例 (7 95 % ) ,未出现与内镜有关并发症。结论 神经内镜适用于复杂性动脉瘤 ,内镜放大、照明和观察死角的作用 ,能更好观察局部解剖 ,可以更确切夹闭动脉瘤蒂 ,降低手术后并发症。
Objective To discuss the role of endoscopic neurosurgery in the surgical treatment of intracranial aneurysms and to analyze its value and shortcomings. Methods Eighty-eight cases (89 aneurysms) of intracranial aneurysm were occluded with endoscopic microsurgery. There were 81 aneurysms in the anterior circulation system (a total of 82 aneurysms) and 7 posterior circulatory system aneurysms. All micro-bone hole approach. All cases before aneurysm clipping, after Doppler ultrasound detection. Among them, 84 cases were assisted by endoscopic neurosurgery (EAM). After the aneurysm was closed under the operation microscope, the structures of the aneurysm pedicle, the branch of the feeding artery and the deep penetrating branch were observed by endoscopy, and the location of the aneurysm clip was confirmed. Neuroendoscope controlled microsurgery (ECM) in 5 cases, under endoscopy can clearly observe the anatomy around the aneurysm, the posterior communicating artery behind the internal carotid artery, the contralateral anterior artery was observed. Results A total of 86 patients underwent 2-week follow-up digital subtraction angiography (DSA), all of which showed satisfactory aneurysm clipping. There was no surgical death and 7 complications (7 95%) after surgery. No complications related to endoscopy were found. Conclusion Neuroendoscope is suitable for complex aneurysms, endoscopic magnification, illumination and observation of dead angle, can better observe the local anatomy, can be more accurate clipping aneurysm pedicle, reducing postoperative complications.