经睑缘前眶隔改良眶颧入路治疗近端前循环破裂动脉瘤
Transblepharo-Preseptal Modified Orbitozygomatic Approach for the Treatment of Ruptured Proximal Anterior Circulation Aneurysms.
作者信息
Rennert Robert C, Strickland Ben A, Ravina Kristine, Bakhsheshian Joshua, Carey Joseph, Russin Jonathan J
机构信息
Department of Neurological Surgery, University of California San Diego, San Diego, USA.
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA.
出版信息
World Neurosurg. 2018 Oct;118:e335-e345. doi: 10.1016/j.wneu.2018.06.188. Epub 2018 Jul 2.
BACKGROUND
Minimally invasive skull base approaches, including the cosmetically optimal transblepharo-preseptal modified orbitozygomatic (TBMOZ) technique, have been described to treat proximal anterior circulation aneurysms. The use of minimally invasive techniques for previously ruptured aneurysms is rare because of perceived technical challenges in controlling intraoperative ruptures. Herein, we determine the utility of the minimally invasive TBMOZ approach for the treatment of ruptured proximal anterior circulation aneurysms.
METHODS
A retrospective analysis of an institutional review board-approved, prospective database was performed to identify patients with ruptured anterior circulation aneurysms treated with a TBMOZ approach. Patient demographics, aneurysm characteristics, temporary clip time, intra-operative ruptures, and neurologic outcomes were recorded.
RESULTS
Fifteen patients (9 females, 6 males; average age, 53.6 ± 12.2 years) underwent a TBMOZ craniotomy following subarachnoid hemorrhage for clipping of 17 aneurysms (12 anterior communicating, 3 posterior communicating, and 2 carotid terminus). Four of 15 patients (26.6%) experienced intraoperative rupture, which was easily controlled in all patients and did not affect clinical outcomes. All patients had complete aneurysm ablation confirmed on postoperative cerebrovascular imaging. Good neurologic outcomes (Glasgow Outcome Score [GOS] of 5) were achieved in 73.3% (n = 11) of patients at time of hospital discharge; the remaining patients had a GOS of 3-4. No patients experienced frontalis muscle weakness or facial nerve injuries, and all patients had acceptable cosmetic outcomes. One patient (6.6%) experienced a surgery-related complication: postoperative versus vasospasm-induced perforator infarcts.
CONCLUSIONS
The TBMOZ approach provides a minimally invasive option for the safe treatment of previously ruptured proximal anterior circulation aneurysms.
背景
微创颅底入路，包括美容效果最佳的经睑板前隔改良眶颧（TBMOZ）技术，已被用于治疗近端前循环动脉瘤。由于在控制术中破裂方面存在技术挑战，微创技术在治疗既往破裂动脉瘤中的应用较少。在此，我们确定微创TBMOZ入路在治疗破裂近端前循环动脉瘤中的效用。
方法
对机构审查委员会批准的前瞻性数据库进行回顾性分析，以确定采用TBMOZ入路治疗的破裂前循环动脉瘤患者。记录患者的人口统计学资料、动脉瘤特征、临时夹闭时间、术中破裂情况及神经功能结局。
结果
15例患者（9例女性，6例男性；平均年龄53.6±12.2岁）在蛛网膜下腔出血后接受TBMOZ开颅手术夹闭17个动脉瘤（12个前交通动脉瘤、3个后交通动脉瘤和2个颈内动脉末端动脉瘤）。15例患者中有4例（26.6%）发生术中破裂，所有患者的破裂均易于控制且未影响临床结局。所有患者术后脑血管成像均证实动脉瘤完全切除。73.3%（n = 11）的患者出院时神经功能结局良好（格拉斯哥预后评分[GOS]为5分）；其余患者GOS评分为3 - 4分。无患者出现额肌无力或面神经损伤，所有患者的美容效果均可接受。1例患者（6.6%）发生手术相关并发症：术后与血管痉挛诱发的穿支梗死。
结论
TBMOZ入路为安全治疗既往破裂的近端前循环动脉瘤提供了一种微创选择。
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