McMahon J H, Morgan M K, Dexter M A
North and West Cerebrovascular unit, Department of Surgery, The University of Sydney, Australia.
J Clin Neurosci. 2001 Jul;8(4):319-24. doi: 10.1054/jocn.2000.0820.
This study reviews the surgical management of contralateral anterior circulation aneurysms in patients with bilateral intracranial aneurysms repaired following a unilateral craniotomy. Between 1993 and 1999, 27 patients had 88 intracranial aneurysms repaired. Eleven patients presented following subarachnoid haemorrhage. Excluding midline aneurysms, 31 anterior circulation aneurysms were contralateral to the craniotomy and all were repaired at the same time that ipsilateral or midline aneurysms were repaired. Morbidity included one death and one case of loss of unilateral vision directly attributable to surgery and two cases of cerebral infarction due to vasospasm. No new neurological deficit or mortality could be directly attributed to the repair of a contralateral aneurysm. The repair of all accessible aneurysms, including those contralateral to the craniotomy, during one session avoids the risk of haemorrhage from incidental or unrecognised ruptured aneurysms (particularly during the aggressive treatment of vasospasm), avoids a second craniotomy, decreases overall hospitalisation and can improve visualisation of carotid-ophthalmic aneurysms.
本研究回顾了单侧开颅修复双侧颅内动脉瘤患者对侧前循环动脉瘤的手术治疗情况。1993年至1999年间，27例患者的88个颅内动脉瘤得到修复。11例患者在蛛网膜下腔出血后就诊。排除中线动脉瘤后，31个前循环动脉瘤位于开颅手术对侧，且均在同侧或中线动脉瘤修复的同时进行了修复。并发症包括1例死亡、1例直接归因于手术的单眼视力丧失以及2例因血管痉挛导致的脑梗死。没有新的神经功能缺损或死亡可直接归因于对侧动脉瘤的修复。在一次手术中修复所有可及的动脉瘤，包括开颅手术对侧的动脉瘤，可避免偶然或未被识别的破裂动脉瘤出血的风险（尤其是在积极治疗血管痉挛期间），避免二次开颅，减少总体住院时间，并可改善颈眼动脉瘤的可视化。
