大脑中动脉分叉部动脉瘤术中载瘤动脉控制的策略
Surgical strategies of parent artery control for middle cerebral bifurcation aneurysm
邵灵敏 1简志宏 1刘仁忠 1熊晓星1
作者信息
- 1. 武汉大学人民医院神经外科 湖北 武汉 430060
- 折叠
摘要
目的:探讨大脑中动脉分叉部动脉瘤夹闭术中载瘤动脉(大脑中动脉M1)暴露的策略及对应的外侧裂开放技巧.方法:回顾性分析经显微手术治疗的112例大脑中动脉分叉部动脉瘤患者的临床资料、术前影像学结果及手术方法等.结果:本组患者平均年龄51.2(36～81)岁.女性发病多见,女∶男=1.87∶1.动脉瘤位于左侧者49例,右侧者63例.蛛网膜下腔出血患者42例,占37.5%.脑血管造影前后位和(或)颅脑CT血管造影(CTA)冠状位上患侧大脑中动脉M1段为上凸型的病例最多,有77例(68.8%),其次为直线型24例(21.4%),下凸型有11例(9.8%).术中从背侧控制M1有75例(67.0%),从腹侧控制M1有37例(33.0%).上凸型中有63例(81.8%)从背侧控制M1;直线型和下凸型中分别有15例(62.5%)和8例(72.7%)需从腹侧控制M1.本组无手术操作导致的静脉梗塞及未成熟动脉瘤破裂.结论:在上凸型中,大多数病例从背侧控制M1是安全的.在远端外侧裂入路暴露载瘤动脉(M1)困难的情况下,追加近端外侧裂的开放,可以从腹侧控制M1.
Abstract
Objective:To investigate the surgical strategies for securing the middle cerebral artery(MCA)horizontal segment(M1)and surgical nuances for dissecting the sylvian fissure.Methods:A total of 112 patients with middle cerebral bifurcation aneurysms treated surgically were included.Medical re-cords,preoperative imaging studies,and surgical techniques were reviewed retrospectively.Results:The mean age in our series was 51.2 years(range:36-81 years).There was a female preponderance(female-male ratio=1.87).Of all the 112 cases,49 suffered from left MCA bifurcation aneurysms,while the others(63 cases)suffered from the right side.Subarachnoid hemorrhage was identified in 42(37.5%)patients.The upward convex course of MCA M1 segments was identified in 77 cases(68.8%)based on preoperative digital subtraction angiography(A-P view)or computed tomography angiography(coronal view),followed by the straight M1 24 cases(21.4%).The down convex M1 segments were found in 11 cases(9.8%).During surgery,M1 were secured from the dorsal side in 75 patients(67%),while the remaining 37 cases(33.0%)were secured from the ventral side.In upward convex group,there were 63 cases(81.8%)in which M1 were secured from dorsal side.Ventral con-trol of M1 were identified in 15 cases(62.5%)in the straight group and 8 cases(72.7%)in down con-vex group respectively.Neither venous infarction nor intra-operative aneurysm rupture resulting from surgery was found in our cohort.Conclusion:In the upward convex M1 group,proximal control from the dorsal side of M1 can be safely achieved in the majority of cases.Additional proximal sylvian fis-sure dissection can be applied to secure ventral M1 when it is difficult to control the parent artery in the distal sylvian fissure approach.
关键词
脑动脉瘤/大脑中动脉/显微手术/外侧裂Key words
Cerebral Aneurysm/Middle Cerebral Artery/Microsurgery/Sylvian Fissure引用本文复制引用
基金项目
湖北省重点实验室开放项目(2021KFY042)
出版年
2024
NETL
NSTL
万方数据