额外侧入路同期夹闭责任动脉瘤对侧大脑中动脉M1段非责任动脉瘤的临床疗效
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1.第一作者;2.天津医科大学总医院

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Clinical effect of simultaneous clipping of the M1-segment of the opposite middle cerebral artery for non-responsible aneurysms through the frontal keyhole approach
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    摘要:

    部分动脉瘤性蛛网膜下出血患者责任病灶对侧发现同时存在干预指征的颅内动脉瘤,尤其是对侧大脑中动脉M1段的动脉瘤的同期治疗存在很大争论及挑战。若患者存在介入治疗禁忌、全身状况或心理不能接受多次开颅手术治疗且颅内多发动脉瘤无法明确责任出血病灶等情况也为手术医师制定诊疗方案带来困难。方法:本团队于2014年6月至2020年9月天津医科大学总医院神经外科共收治8例动脉瘤性蛛网膜下出血经单侧额外侧入路夹闭责任出血动脉瘤对侧大脑中动脉M1段非责任动脉瘤患者,通过描述Fisher分级、Hunt-Hess分级、责任动脉瘤位置、对侧大脑中动脉瘤距离同侧M1段起点的长度(mm)、对侧大脑中动脉瘤朝向及大小(mm)、出院时mRS评分、出院时MoCA评分等评估此手术方式的疗效。结果:8例患者共18个动脉瘤,16个需要手术治疗的颅内动脉瘤,出血责任动脉瘤位于颈内动脉4例,前交通动脉2例,大脑中动脉2例。对侧大脑中动脉瘤距离同侧M1段起点的长度平均15.4mm。需要处理的对侧大脑中动脉瘤平均3.4*2.6mm。术后复查头血管CTA见病灶远端颅内动脉走行自然,管壁光滑,病灶局部未见局限性狭窄或扩张。出院时有4例mRS评分为0;4例患者评分为1。出院时MoCA评分提示有2例患者存在轻度认知功能障碍(小于26分),余患者认知功能正常。结论:单侧额外侧入路治疗对侧非责任病变有很多优势且在技术上是可行的,为这类复杂病变的治疗提供了新思路。

    Abstract:

    In some aneurysmal patients with SAH, IAs with surgical indications will be found on the contralateral side of the primary lesion, especially for aneurysms in the M1 segment of the contralateral MCA. If patients have obvious contraindications of interventional therapy, psychological barriers that they cannot accept multiple craniotomies, and they cannot identify MIAs with responsible lesions, it will be difficult for surgeons to make surgical diagnosis and treatment plans. Method:From June 2018 to September 2020, our team admitted a total of 8 aneurysmal patients with SAH who had non-responsible aneurysms in the M1 segment of the contralateral MCA of responsible aneurysm clipping through unilateral keyhole approach. Fisher grading, Hunt-Hess grading, location of the responsible aneurysm, distance between contralateral MCA and the beginning of ipsilateral M1 segment (mm), orientation and size of the non-responsible aneurysm(mm), mRS score at discharge, MoCA score at discharge and so on were described to evaluate the efficacy of this surgical method. Result:There were a total of 18 aneurysms in 8 patients, including 16 intracranial aneurysms requiring surgical treatment, including 4 cases of responsible hemorrhage aneurysms located in the internal carotid artery, 2 cases in anterior communicating artery and 2 cases in the MCA. The median length of the contralateral middle cerebral aneurysm from the beginning of the ipsilateral M1 segment was 15.4mm. The average diameter of nonresponsible aneurysms requiring treatment was 3.4*2.6mm. Postoperative cerebrovascular CTA showed that the intracranial artery at the distal end of the lesion moved naturally, the wall of the lesion was smooth, and there was no local stenosis or expansion of the lesion. MRS score of 4 patients was 0 at discharge. The score of 4 patients was 1. MoCA score at discharge suggested that 2 patients had mild cognitive impairment (< 26 points), and the remaining patients had normal cognitive function. Conclusion: Unilateral keyhole approach for the treatment of contralateral non-responsible aneurysms has many advantages and is technically feasible, providing a new idea for the treatment of such complex lesions.

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  • 收稿日期:2022-01-11
  • 最后修改日期:2022-05-17
  • 录用日期:2022-06-10
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