摘要目的 探讨锁孔入路手术治疗颈内动脉眼动脉段动脉瘤的手术技巧.方法 回顾性分析苏州大学附属第二医院神经外科2006年9月至2013年12月采用锁孔微创入路手术治疗28例颈内动脉眼动脉段动脉瘤患者的临床资料,包括大动脉瘤6例,巨大动脉瘤9例;破裂动脉瘤13例,未破裂动脉瘤15例;5例伴有多发性动脉瘤.其中经眉弓额下锁孔入路22例(对侧入路2例),翼点锁孔入路6例.结果 28例眼动脉动脉瘤中夹闭27例,1例后交通动脉侧支循环良好,予以孤立术;5例多发动脉瘤在同一入路下行一期夹闭;术中4例动脉瘤因瘤内血栓巨大,需切除血栓才能完好夹闭;20例患者予前床突磨除.术后复查有2例巨大动脉瘤瘤颈稍有残留.术后1例脑脊液鼻漏,采用经蝶窦入路手术修补;1例术前同侧视力光感,术后患侧失明;2例术后出现脑梗死;其余患者术后情况良好.结论 在锁孔入路下可进行前床突磨除、载瘤动脉塑形、瘤内血栓切除、多个瘤夹组合及加强夹闭等,能够较好地夹闭眼动脉动脉瘤;经眉弓额下锁孔入路适用于绝大多数眼动脉动脉瘤患者,对眉毛浅淡、动脉瘤宽颈并指向颈内动脉外侧者可采用翼点锁孔入路手术.

abstractsObjective To investigate the surgical skills of keyhole approach in the treatment of aneurysms of the ophthalmic segment of internal carotid artery.Methods The clinical data of 28 patients with aneurysms at the internal carotid-ophthalmic artery segment operated via keyhole approach at the Department of Neurosurgery,the Second Affiliated Hospital of Soochow University from September 2006 to December 2013 were analyzed retrospectively,including 6 large aneurysms and 9 giant aneurysms.Thirteen patients had ruptured aneurysms,15 had unruptured aneurysms,and 5 accompanied with multiple aneurysms.Twenty-two of them were treated via the supraorbital keyhole approach (2 via contralateral approach),and 6 via the pterional keyhole approach.Results Of the 28 ophthalmic artery aneurysms,27 were clipped,1 was good in the collateral circulation of posterior communicating artery and was trapped;5 patients with multiple aneurysms underwent one-stage clipping via the same approach.Because of the huge thrombi in the aneurysms,only removal of the thrombi in 4 aneurysms during the operation,could they be clipped completely;20 patients were treated with the removal of the anterior clinoid process.Reexamination after procedure,the necks of 2 giant aneurysms had slight residues.One patient had cerebrospinal fluid rhinorrhea after procedure and was repaired via sphenoidal approach;1 patient lost his ipsilateral sight with preoperative ipsilateral visual light perception;2 had cerebral infarction after procedure.The other patients were good after procedure.Conclusions Under the keyhole approach,the removal of the anterior clinoid process,parent artery remodeling,thrombectomy in aneurysms,multiple clips and strengthening clipping can be performed.The supraorbital keyhole approach is applicable to most of the patients with ophthalmic artery aneurysm,while the patients with pale eyebrows and wide-necked aneurysms pointing to the outside of internal carotid artery,the pterional keyhole approach can be used.