目的 探讨经额下入路显微手术治疗破裂的急性期前交通动脉瘤的方法和疗效.方法 潍坊市人民医院脑科医院神经外科自2007年1月至2010年10月经额下入路显微手术治疗破裂的前交通动脉瘤患者32例,回顾性分析患者的临床资料、手术方法和疗效. 结果 本组32例患者32个动脉瘤,均手术成功夹闭.应用42个动脉瘤夹,术中发生动脉瘤破裂出血7例(21.88％)；术后随访6～12个月,GOS预后评分显示恢复良好26例(81.25％),轻残5例(15.63％),重残1例(3.13％),无植物生存、死亡、颅内感染及脑脊液漏病例. 结论 经额下入路显微手术治疗前交通动脉瘤能够直达前交通动脉复合体,可以缩短手术时间,减少对侧裂血管的损伤,显露充分,夹闭满意.%Objective To discuss the microsurgical treatment of anterior communicating artery (ACoA) aneurysms at acute stage vit the supffontal approach. Methods Thirty-two patients with ruptured ACoA aneurysms,admitted to our hospital from January 2007 to October 2010 and underwent mierosurgery through supfrontal approach, were chosen in our study; their clinical manifestations,surgical methods and treatment efficacy were retrospectively analyzed. Results All 32 ACoA aneurysms in these 32 patients were clipped successfully.Forty-two aneurysm clips were used during the surgery; intraoperative aneurysm rupture occurred in 7 patients (21.88％). According to scores of Glasgow Outcome scale after 6-12 months of follow-up,26 patients (81.25％) enjoyed good results,5 (15.63％) had moderate disability and 1 (3.13％) had severe disability; no patients died,and no patients were having intracranial infection, having cerebrospinal leak or under vegetative state. Conclusion Microsurgical operation of anterior communicating aneurysms via subfronal approach was an effective and rapid method with minimal exposure and reliable neck clipping.
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