眶翼点入路治疗前交通动脉瘤的解剖学与临床研究

Anatomic and clinical study of the orbitopterional approach to anterior communicating artery aneurysms.

作者信息

Andaluz Norberto, Van Loveren Harry R, Keller Jeffrey T, Zuccarello Mario

机构信息

The Neuroscience Institute, Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, USA.

出版信息

Neurosurgery. 2003 May;52(5):1140-8; discussion 1148-9.

PMID:12699559

Abstract

OBJECTIVE

To evaluate the orbitopterional approach to anterior communicating artery (AComA) aneurysms, on the basis of the quantification of this surgical exposure, compared with the pterional approach, in a cadaveric study and a retrospective review of data for 40 patients who underwent clipping of AComA aneurysms via the orbitopterional approach.

METHODS

In an anatomic study, four cadaveric heads underwent pterional craniotomies on the left side and orbitopterional craniotomies on the right side. A fifth head was initially subjected to bilateral pterional craniotomies and then underwent bilateral orbital osteotomies, for direct comparison of these approaches. Using frameless stereotaxy, we quantified the angles of exposure and surgical field depths provided by the pterional and orbitopterional craniotomies. In a clinical study, 40 patients who underwent clipping of AComA aneurysms via orbitopterional approaches were evaluated for basal brain injury, the need for resection of the gyrus rectus, dissection of the sylvian fissure, and approach-related complications. The incidence of postoperative hydrocephalus among patients with subarachnoid hemorrhage who underwent lamina terminalis fenestration was also reviewed.

RESULTS

The angles of observation were increased 46% in the axial plane (orbitopterional, 72.92 +/- 6.57 degrees; pterional, 49.75 +/- 2.27 degrees; P < 0.01) and 137.5% in the projection plane (orbitopterional, 8 +/- 2.19 degrees; pterional, 19 +/- 1.78 degrees; P < 0.01). The surgical window depth was decreased 13% with the orbitopterional approach (P < 0.05). Clinically, there was no incidence of frontobasal hypodensities on postoperative computed tomographic scans. Three patients (7.5%) required resection of the gyrus rectus. No patient required sylvian fissure dissection for aneurysm exposure. Two of 29 patients (6.9%) who survived subarachnoid hemorrhage required ventriculoperitoneal shunts despite lamina terminalis fenestration. No approach-related complications were recognized.

CONCLUSION

The orbitopterional approach improved the observation of the AComA complex and seemed to decrease the risk of intraoperative brain damage.

摘要

目的

在一项尸体研究以及对40例经眶翼点入路夹闭前交通动脉（AComA）动脉瘤患者的数据进行回顾性分析的基础上，通过量化手术暴露情况，评估眶翼点入路治疗AComA动脉瘤的效果，并与翼点入路进行比较。

方法

在解剖学研究中，对4个尸头左侧行翼点开颅术，右侧行眶翼点开颅术。第5个尸头先双侧行翼点开颅术，然后行双侧眶骨切开术，以便直接比较这些入路。使用无框架立体定向技术，我们量化了翼点和眶翼点开颅术提供的暴露角度和手术视野深度。在临床研究中，对40例经眶翼点入路夹闭AComA动脉瘤的患者进行评估，观察其基底脑损伤情况、是否需要切除直回、解剖外侧裂以及与入路相关的并发症。还回顾了蛛网膜下腔出血患者行终板造瘘术后脑积水的发生率。

结果

在轴位平面，观察角度增加了46%（眶翼点入路，72.92±6.57度；翼点入路，49.75±2.27度；P<0.01），在投影平面增加了137.5%（眶翼点入路，8±2.19度；翼点入路，19±1.78度；P<0.01）。眶翼点入路的手术窗口深度减少了13%（P<0.05）。临床上，术后计算机断层扫描未发现额底部低密度影。3例患者（7.5%）需要切除直回。没有患者因暴露动脉瘤而需要解剖外侧裂。29例蛛网膜下腔出血存活患者中有2例（6.9%）尽管行了终板造瘘术仍需要行脑室腹腔分流术。未发现与入路相关的并发症。