Kelleher M O, Kamel M H, O'Sullivan M G J
Department of Neurosurgery, Cork University Hospital, Cork, Eire.
Br J Neurosurg. 2005 Oct;19(5):413-5. doi: 10.1080/02688690500390110.
Certain aneurysms of the anterior circulation continue to offer a technical challenge for safe exposure and clipping. The purpose of this paper was to describe the cranio-orbital approach for surgical clipping of complex aneurysms and to evaluate prospectively the associated complications of this approach. Prospective audit of all patients undergoing cranio-orbital approach for aneurysm surgery from 1997 to 2004 by the senior author. Twenty-five patients, eight male and 17 female, median age of 52 years, range 28-73. All patients had a standard pterional approach supplemented by an orbital osteotomy. In the 7-year period 367 patients underwent treatment for their aneurysms (169 clipped and 198 coiled). Of the 169 patients who were operated on, 29 had a skull base approach, of which 25 were cranio-orbital. The aneurysm location was as follows: 16 middle cerebral artery (MCA), three carotid bifurcation, four anterior communicating artery (ACOMM), one ophthalmic and one basilar. There were no approach-related complications. The cranio-orbital craniotomy can be a useful adjunct in the surgical treatment of giant or complex aneurysms. It offers the following advantages over a standard pterional approach: reduces operative distance; allows easy splitting of the sylvian fissure; and provides a wide arc of exposure with multiple working corridors.
某些前循环动脉瘤在安全暴露和夹闭方面仍然存在技术挑战。本文的目的是描述用于复杂动脉瘤手术夹闭的颅眶入路，并前瞻性评估该入路的相关并发症。资深作者对1997年至2004年期间所有接受颅眶入路动脉瘤手术的患者进行前瞻性审计。25例患者，8例男性和17例女性，中位年龄52岁，范围28 - 73岁。所有患者均采用标准翼点入路并辅以眶骨切开术。在这7年期间，367例患者接受了动脉瘤治疗（169例夹闭，198例栓塞）。在接受手术的169例患者中，29例采用颅底入路，其中25例为颅眶入路。动脉瘤位置如下：16例大脑中动脉（MCA），3例颈动脉分叉，4例前交通动脉（ACOMM），1例眼动脉和1例基底动脉。没有与入路相关的并发症。颅眶开颅术在巨大或复杂动脉瘤的手术治疗中可能是一种有用的辅助方法。与标准翼点入路相比，它具有以下优点：缩短手术距离；便于分离外侧裂；并提供多个工作通道的宽暴露范围。
