Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery.
Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery.
复制标题
双额纵裂入路治疗前交通动脉瘤。
作者：
J. Suzuki;K. Mizoi;T. Yoshimoto
作者回顾了他们使用双额半球间入路治疗 603 例单前交通动脉 (ACoA) 动脉瘤的经验，并描述了手术技术。通过这种方法，解剖嗅束，并在额下识别大脑前动脉的两个 A1 段。然后解剖半球间裂，并沿着 A2 段从远端部分向 ACoA 复合体延伸。在联合使用甘露醇、维生素 E 和地塞米松后，在解剖动脉瘤本身之前，至少在主要的 A1 节段上放置一个临时夹子。一旦动脉瘤与周围结构完全分离，就会结扎并夹闭颈部。如果动脉瘤在手术过程中破裂，则在两侧 A1 和 A2 段上放置临时夹子，并在完全干燥的场地中进行手术。通过这种方法，可以在给药100分钟内将任何颅内血管闭塞长达40分钟。为了防止动脉瘤手术前再次破裂和发生血管痉挛的可能性，作者采取了在症状出现后 48 小时内进行超早期手术的政策。自1975年以来的9年时间里，共进行了257例手术，其中五分之一是在破裂后48小时内进行的手术，院内死亡率仅为4.3%（11例）。后续研究表明，246名幸存患者中，87%已恢复正常生活。
The authors review their experience with the bifrontal interhemispheric approach in 603 cases of single anterior communicating artery (ACoA) aneurysms and describe the operative technique. With this approach, the olfactory tracts are dissected, and both A1 segments of the anterior cerebral arteries are identified subfrontally. The interhemispheric fissure is then dissected and A2 segments are followed from the distal portion toward the ACoA complex. Following the administration of a combination of mannitol, vitamin E, and dexamethasone, a temporary clip is placed on at least the dominant A1 segment prior to dissection of the aneurysm itself. Once the aneurysm has been completely freed from the surrounding structures, the neck is ligated and clipped. If the aneurysm ruptures during surgery, temporary clips are placed on both A1 and A2 segments bilaterally and the operation proceeds in a completely dry field. With this method, it is possible to occlude any of the intracranial vessels for up to 40 minutes within 100 minutes of drug administration. To prevent the possibility of rerupture and the development of vasospasm in the period before aneurysm surgery, the authors have adopted a policy of performing ultra-early operations within 48 hours of the onset of symptoms. Among the 257 cases operated on during the 9 years since 1975, one-fifth have been operated on within 48 hours of rupture, and the in-hospital mortality rate has been only 4.3% (11 cases). Follow-up studies have shown that 87% of the 246 surviving patients have returned to useful lives.