Division of Neurosurgery, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil.
Hospital Israelita Albert Einstein, São Paulo, Brazil.
Oper Neurosurg (Hagerstown). 2017 Aug 1;13(4):453-464. doi: 10.1093/ons/opx021.
Although recent technological advances have led to successful endovascular treatment, middle cerebral artery (MCA) aneurysms are still prone to surgery. Because minimally invasive options are limited and possess several functional and cosmetic drawbacks, a transpalpebral approach is proposed as a new alternative.
To describe and assess surgical results of the minimally invasive transpalpebral approach in patients with MCA aneurysms.
The data of 25 patients with unruptured MCA aneurysms from 2013 to 2016 were included in a cohort prospective database. We describe modifications of the approach and technique for MCA aneurysm clipping, in a step-by-step manner. The outcome was based on complications, procedural morbidity and mortality, and clinical and angiographic outcomes.
All procedures were successfully performed in a standardized way, and no major complications related to the new approach were observed. Twenty-two patients were discharged the day after surgery (88%). The majority of aneurysms were 5 to 6 mm in diameter (mean, 7 mm; range 4-21 mm). All patients underwent postoperative angiographic control, which showed no significant residual neck. A 3-mo follow-up was sufficient to show no visible scars with excellent cosmetic results. The mean duration of follow-up was 16 mo.
The transpalpebral approach comes as a minimally invasive, safe, definitive, and cosmetically adequate solution for MCA aneurysms at the present time.
尽管最近的技术进步已经实现了成功的血管内治疗，但大脑中动脉（MCA）动脉瘤仍然容易发生手术。由于微创选择有限并且存在几种功能和美容缺陷，因此提出经眼睑入路作为一种新的选择。
描述并评估微创经眼睑入路治疗 MCA 动脉瘤患者的手术结果。
我们将 2013 年至 2016 年间的 25 例未破裂 MCA 动脉瘤患者的数据纳入前瞻性队列数据库。我们以逐步的方式描述 MCA 动脉瘤夹闭的方法和技术的改进。结果基于并发症、程序发病率和死亡率以及临床和血管造影结果。
所有手术均以标准化方式成功进行，未观察到与新方法相关的重大并发症。22 例患者术后次日出院（88％）。大多数动脉瘤的直径为 5 至 6 毫米（平均 7 毫米；范围 4-21 毫米）。所有患者均进行了术后血管造影检查，结果显示无明显残留颈部。3 个月的随访足以显示无明显疤痕，美容效果极佳。平均随访时间为 16 个月。
目前，经眼睑入路是治疗 MCA 动脉瘤的微创、安全、明确和美容效果良好的方法。
