Microsurgery Treatment of Ruptured Middle Cerebral Artery Aneurysms_West China Medical Journal

Authors：

MAO Ke , LI Jin , HE Ming ,  YOU Chao

Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

YOU Chao, Email: babyface1243@126.com

Keywords：

大脑中动脉动脉瘤; 翼点入路; 显微外科

Video：

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目的　探讨显微手术治疗破裂大脑中动脉动脉瘤（MCAA）的适应证、术前评估及手术技巧。方法　回顾性分析2008年1月－2011年1月经翼点入路行显微外科手术治疗的65例破裂MCAA患者的临床资料。其中男40例，女25例；年龄22～78岁，平均46.8岁。术前Hunt-Hess分级：Ⅰ级15例，Ⅱ级25例，Ⅲ级13例，Ⅳ级10例，Ⅴ级2例。动脉瘤直径＜5 mm 10个，5～15 mm 36个，15～25 mm 15个，＞25 mm 4个，平均7.8 mm。其中56例动脉瘤位于大脑中动脉分叉部，5例位于大脑中动脉的M1段，4例位于分叉后M2段。结果　手术夹闭动脉瘤60例，余5例行动脉瘤夹闭加包裹术。患者术后获随访3～36个月，平均16个月，均无动脉瘤复发或再出血发生。按格拉斯哥预后评分（GOS）结果评定：恢复良好58例（GOS 4～5分），差5例（GOS 2～3分），死亡2例（GOS 1分）。结论　充分的术前评估，合适的手术入路选择，以及手术技巧的灵活应用是显微外科手术成功治疗破裂MCAA的保证。

Citation： MAO Ke,LI Jin,HE Ming,YOU Chao. Microsurgery Treatment of Ruptured Middle Cerebral Artery Aneurysms. West China Medical Journal, 2012, 27(5): 673-676. doi: Copy

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.
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6.	丰育功, 荆友斌, 张丽云, 等. 三维CT血管造影在颅内动脉瘤诊治中的应用[J]．中华神经外科杂志, 2009, 25(11): 996-998．.
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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.	陈志, 冯华, 吴南, 等. 术中微血管多普勒超声在颅内动脉瘤手术中的初步应用[J].中华神经外科杂志, 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. 　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. 　丰育功, 荆友斌, 张丽云, 等. 三维CT血管造影在颅内动脉瘤诊治中的应用[J]．中华神经外科杂志, 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. 　刘翼, 游潮, 贺民, 等. 颅内破裂动脉瘤手术时机的探讨(附237例分析)[J]. 中国微侵袭神经外科杂志, 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. 　陈志, 冯华, 吴南, 等. 术中微血管多普勒超声在颅内动脉瘤手术中的初步应用[J].中华神经外科杂志, 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.

West China Medical Journal

Microsurgery Treatment of Ruptured Middle Cerebral Artery Aneurysms

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