Martellotta N, Gigante N, Toscano S, Maddalena G F, Tripodi M, Settembrini G, Stroscio C, Distefano G, Citro E
Department of Neurological Sciences, Neurosurgery, A Perrino Hospital, Brindisi, Italy.
Minim Invasive Neurosurg. 2003 Aug;46(4):228-30. doi: 10.1055/s-2003-42359.
A left middle cerebral artery aneurysm at the bifurcation (M1-M2 segment) and a right smaller aneurysm, symmetrical to the previous one were diagnosed in a 69-year-old female after angiographic examination for subarachnoid hemorrhage. The preoperative radiological study did not enable us to identify the bleeding aneurysm so a left supraorbital keyhole approach was performed to operate on the bigger aneurysm. In the same surgical session, using the same way of approach, we decided to attack also the right aneurysm which then revealed itself as being responsible for bleeding. The postoperative angiograms confirmed the complete exclusion of both aneurysms and the patient was discharged after good recovery. Although there are remarkable controversies about the surgical strategies for multiple aneurysms, our experience gives us the opportunity to emphasize the supraorbital keyhole approach and to reconsider the "timing" of multiple/bilateral aneurysms.
一位69岁女性在因蛛网膜下腔出血接受血管造影检查后，被诊断出在大脑中动脉分叉处（M1-M2段）有一个左侧动脉瘤，以及一个与前一个对称的右侧较小动脉瘤。术前影像学研究无法确定出血的动脉瘤，因此采用左侧眶上锁孔入路对较大的动脉瘤进行手术。在同一手术过程中，采用相同的入路方式，我们决定同时处理右侧动脉瘤，结果发现它是出血的责任动脉瘤。术后血管造影证实两个动脉瘤均被完全排除，患者恢复良好后出院。尽管对于多发性动脉瘤的手术策略存在显著争议，但我们的经验让我们有机会强调眶上锁孔入路，并重新考虑多发性/双侧动脉瘤的“手术时机”。
