• 四川大學(xué)華西醫(yī)院神經(jīng)外科（成都，610041）;

目的 　探討顯微手術(shù)治療破裂大腦中動(dòng)脈動(dòng)脈瘤（MCAA）的適應(yīng)證、術(shù)前評(píng)估及手術(shù)技巧。 方法 　回顧性分析2008年1月－2011年1月經(jīng)翼點(diǎn)入路行顯微外科手術(shù)治療的65例破裂MCAA患者的臨床資料。其中男40例，女25例；年齡22～78歲，平均46.8歲。術(shù)前Hunt-Hess分級(jí)：Ⅰ級(jí)15例，Ⅱ級(jí)25例，Ⅲ級(jí)13例，Ⅳ級(jí)10例，Ⅴ級(jí)2例。動(dòng)脈瘤直徑＜5 mm 10個(gè)，5～15 mm 36個(gè)，15～25 mm 15個(gè)，＞25 mm 4個(gè)，平均7.8 mm。其中56例動(dòng)脈瘤位于大腦中動(dòng)脈分叉部，5例位于大腦中動(dòng)脈的M1段，4例位于分叉后M2段。 結(jié)果 　手術(shù)夾閉動(dòng)脈瘤60例，余5例行動(dòng)脈瘤夾閉加包裹術(shù)?；颊咝g(shù)后獲隨訪(fǎng)3～36個(gè)月，平均16個(gè)月，均無(wú)動(dòng)脈瘤復(fù)發(fā)或再出血發(fā)生。按格拉斯哥預(yù)后評(píng)分（GOS）結(jié)果評(píng)定：恢復(fù)良好58例（GOS 4～5分），差5例（GOS 2～3分），死亡2例（GOS 1分）。 結(jié)論 　充分的術(shù)前評(píng)估，合適的手術(shù)入路選擇，以及手術(shù)技巧的靈活應(yīng)用是顯微外科手術(shù)成功治療破裂MCAA的保證。

引用本文： 毛珂,李進(jìn),賀民,游潮. 顯微手術(shù)治療破裂大腦中動(dòng)脈動(dòng)脈瘤. 華西醫(yī)學(xué), 2012, 27(5): 673-676. doi: 復(fù)制

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1. 　Rinne J, Shen H, Kiivisaari R, et al. Surgical management of aneurusyms of middle cerebral artery[M]//Schmidick HH, Sweet WH. Operative neurosurgical techniques，indications，methods and results. New York: WB Saunders, 2000: 1159-1180.
2. 　Suzuki J, Yoshimoto T, Kayama T, et al. Surgical treatment of middle cerebral artery aneurysms [J]. J Neurosurg， 1984， 61(1): 17-23.
3. 　Wanebo JE, Zabramski JM, Spetaler RF. Superficial temporal artery to middle cerebral artery bypass grafting for cerebral revascularization [J]. Neurosurgery, 2004, 55(2): 395-399.
4. 　Heros RC, Fritsch MJ. Surgical management of middle cerebral artery aneurysms [J]. Neurosurgery, 2001, 48(4): 780-786.
5. 　Ahn JY, Han IB, Joo JY. Aneurysm in the penetrating artery of the distal middle cerebral artery presenting as intracerebral hemorrhage [J]. Acta Neurochir (Wien), 2005, 147(12): 1287-1290.
6. 　豐育功, 荊友斌, 張麗云, 等. 三維CT血管造影在顱內(nèi)動(dòng)脈瘤診治中的應(yīng)用[J]．中華神經(jīng)外科雜志, 2009, 25(11): 996-998．.
7. 　Tipper G, U-King-Im JM, Price SJ, et al. Detection and evaluation of intracranial aneurysms with 16-row multislice CT angiography[J]. Clin Radiol, 2005, 60(5): 565-572.
8. 　劉翼, 游潮, 賀民, 等. 顱內(nèi)破裂動(dòng)脈瘤手術(shù)時(shí)機(jī)的探討(附237例分析)[J]. 中國(guó)微侵襲神經(jīng)外科雜志, 2007, 12(5): 199-201．.
9. 　Tawk RG, Pandey A, Levy E, et al. Coiling of ruptured aneurysm followed by evacuation of hematoma[J]. World Neurosurg, 2010, 74(6): 626-631.
10. 　Dashti R, Hernesniemi J, Niemelä M, et al. Microneurosurgical management of middle cerebral artery bifurcation aneurysms[J]. Surg Neurol, 2007, 67(5): 441-456.
11. 　Kazumata K, Kamiyama H, Yokoyama Y, et al. Poor-grade ruptured middle cerebral artery aneurysm with intracerebral hematoma: bleeding characteristics and management[J]. Neurol Med Chir (Tokyo), 2010, 50(10): 884-892.
12. 　Morgan MK, Mahattanakul W, Davidson A, et al. Outcome for middle cerebral artery aneurysm surgery[J]. Neurosurgery, 2010, 67(3): 755-761.
13. 　陳志, 馮華, 吳南, 等. 術(shù)中微血管多普勒超聲在顱內(nèi)動(dòng)脈瘤手術(shù)中的初步應(yīng)用[J].中華神經(jīng)外科雜志, 2005, 43(1): 69-70.
14. 　Taki W, Sakai N, Suzuki H, et al. Determinants of poor outcome after aneurysmal subarachnoid hemorrhage when both clipping and coiling are available: Prospective Registry of Subarachnoid Aneurysms Treatment （PRESAT） in Japan[J]. World Neurosurg, 2011, 76(5): 437-445.
  1. 1. 　Rinne J, Shen H, Kiivisaari R, et al. Surgical management of aneurusyms of middle cerebral artery[M]//Schmidick HH, Sweet WH. Operative neurosurgical techniques，indications，methods and results. New York: WB Saunders, 2000: 1159-1180.
  2. 2. 　Suzuki J, Yoshimoto T, Kayama T, et al. Surgical treatment of middle cerebral artery aneurysms [J]. J Neurosurg， 1984， 61(1): 17-23.
  3. 3. 　Wanebo JE, Zabramski JM, Spetaler RF. Superficial temporal artery to middle cerebral artery bypass grafting for cerebral revascularization [J]. Neurosurgery, 2004, 55(2): 395-399.
  4. 4. 　Heros RC, Fritsch MJ. Surgical management of middle cerebral artery aneurysms [J]. Neurosurgery, 2001, 48(4): 780-786.
  5. 5. 　Ahn JY, Han IB, Joo JY. Aneurysm in the penetrating artery of the distal middle cerebral artery presenting as intracerebral hemorrhage [J]. Acta Neurochir (Wien), 2005, 147(12): 1287-1290.
  6. 6. 　豐育功, 荊友斌, 張麗云, 等. 三維CT血管造影在顱內(nèi)動(dòng)脈瘤診治中的應(yīng)用[J]．中華神經(jīng)外科雜志, 2009, 25(11): 996-998．.
  7. 7. 　Tipper G, U-King-Im JM, Price SJ, et al. Detection and evaluation of intracranial aneurysms with 16-row multislice CT angiography[J]. Clin Radiol, 2005, 60(5): 565-572.
  8. 8. 　劉翼, 游潮, 賀民, 等. 顱內(nèi)破裂動(dòng)脈瘤手術(shù)時(shí)機(jī)的探討(附237例分析)[J]. 中國(guó)微侵襲神經(jīng)外科雜志, 2007, 12(5): 199-201．.
  9. 9. 　Tawk RG, Pandey A, Levy E, et al. Coiling of ruptured aneurysm followed by evacuation of hematoma[J]. World Neurosurg, 2010, 74(6): 626-631.
  10. 10. 　Dashti R, Hernesniemi J, Niemelä M, et al. Microneurosurgical management of middle cerebral artery bifurcation aneurysms[J]. Surg Neurol, 2007, 67(5): 441-456.
  11. 11. 　Kazumata K, Kamiyama H, Yokoyama Y, et al. Poor-grade ruptured middle cerebral artery aneurysm with intracerebral hematoma: bleeding characteristics and management[J]. Neurol Med Chir (Tokyo), 2010, 50(10): 884-892.
  12. 12. 　Morgan MK, Mahattanakul W, Davidson A, et al. Outcome for middle cerebral artery aneurysm surgery[J]. Neurosurgery, 2010, 67(3): 755-761.
  13. 13. 　陳志, 馮華, 吳南, 等. 術(shù)中微血管多普勒超聲在顱內(nèi)動(dòng)脈瘤手術(shù)中的初步應(yīng)用[J].中華神經(jīng)外科雜志, 2005, 43(1): 69-70.
  14. 14. 　Taki W, Sakai N, Suzuki H, et al. Determinants of poor outcome after aneurysmal subarachnoid hemorrhage when both clipping and coiling are available: Prospective Registry of Subarachnoid Aneurysms Treatment （PRESAT） in Japan[J]. World Neurosurg, 2011, 76(5): 437-445.