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目的报道经眶上“锁孔”入路和经翼点“锁孔”入路显微手术治疗颅内动脉瘤的临床疗效。方法回顾分析165例颅内动脉瘤“锁孔”手术临床资料,其中采用眶上“锁孔”入路106例共108个动脉瘤,翼点“锁孔”入路59例,共62个动脉瘤。结果眶上“锁孔”组有103个动脉瘤夹闭成功,行包裹术1例,孤立术2例,孤立加切除术2例。翼点“锁孔”组61个动脉瘤一次夹闭成功,行孤立术1例。根据GOS评估标准,眶上“锁孔”组恢复良好98例,轻残2例,死亡6例,翼点“锁孔”组恢复良好53例,轻残5例,死亡1例。结论眶上与翼点“锁孔”入路疗效相近,均可适用于颈内动脉、眼动脉、大脑前动脉水平段、前交通动脉、大脑前动脉垂直段近端、基底动脉分叉部及大脑后动脉前段动脉瘤手术夹闭．欲行对侧眼动脉、大脑前动脉水平段、垂直段近端及颈内动脉动脉瘤手术,以选择眶上“锁孔”人路更合适。本方法具有手术创伤小、疗效佳、并发症少、外观影响少和费用节省等优点,是颅内动脉瘤显微手术有效和理想的人路。
Objective To report the clinical effects of microsurgical treatment of intracranial aneurysms via supraorbital “keyhole” approach and pterional “keyhole” approach. Methods A retrospective analysis of 165 cases of intracranial aneurysm “keyhole surgery” clinical data, including the use of supraorbital “keyhole” approach 106 cases of a total of 108 aneurysms, wing point “keyhole” approach 59 cases, a total of 62 arteries tumor. Results In the supraorbital “keyhole” group, 103 aneurysms were successfully occluded, including 1 case of parcel occlusion, 2 cases of orphaned excision and 2 cases of solitary excision. Wing point “keyhole” group of 61 aneurysms clipped successfully, line solitary surgery in 1 case. According to the GOS assessment criteria, there were 98 cases recovered well, 2 cases lightly disabled, 6 cases died, and 53 cases recovered well in the “lock hole” group, 5 cases were mild residual and 1 died. Conclusions The supraorbital approach is similar to the “keyhole” approach of the wing point, and it is applicable to the internal carotid artery, the ophthalmic artery, the anterior cerebral artery, the anterior communicating artery, the proximal segment of the anterior cerebral artery, the basilar artery bifurcation, Anterior cerebral artery aneurysm surgery closed. For the ophthalmic ophthalmic artery, the anterior cerebral artery horizontal segment, the vertical segment of the proximal and internal carotid artery aneurysm surgery to select the supraorbital “keyhole” path more appropriate. The method has the advantages of small operation trauma, good curative effect, less complications, less appearance impact, and cost saving, and is an effective and ideal microsurgery for intracranial aneurysms.