Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
World Neurosurg. 2024 Jul;187:e282-e288. doi: 10.1016/j.wneu.2024.04.075. Epub 2024 Apr 18.
Keyhole surgery has been widely used to clip various intracranial aneurysms. Here, the feasibility of microsurgical clipping of multiple intracranial aneurysms via the keyhole approach was further investigated.
The clinical data of 80 patients with multiple intracranial aneurysms treated with keyhole surgery were retrospectively analyzed. The patients included 25 males and 55 females, with an average age of 57.5 years. There were 13 patients with unruptured aneurysms, 67 patients with ruptured aneurysms (small aneurysms accounted for 52.2% of ruptured aneurysms), and a total of 198 aneurysms. A 4 cm incision and a bone hole of approximately 2.5 cm were used per craniotomy standards. Forty-eight cases were treated via the supraorbital keyhole approach, 45 cases via the pterional keyhole approach, and 3 cases via the interhemispheric keyhole approach.
A bilateral and unilateral keyhole approach was applied in 18 and 62 cases, respectively. A total of 170 ipsilateral and 7 contralateral aneurysms were clipped. The complete clipping rate was 98.9%. During the follow-up period of 6-12 months after surgery, the Glasgow outcome scale score was 5 points in 74 cases, 4 points in 5 cases, and 3 points in 1 case. The prognosis was associated with the preoperative Hunt-Hess classification but not with the number of operative sides, the operation opportunity, or the number of clipped aneurysms.
Early keyhole surgical clipping of multiple intracranial aneurysms is an effective treatment. Among ruptured aneurysms, small aneurysms are common and need attention and timely treatment.
锁孔手术已广泛应用于夹闭各种颅内动脉瘤。在此，进一步探讨了通过锁孔入路显微手术夹闭多发颅内动脉瘤的可行性。
回顾性分析 80 例采用锁孔手术治疗的多发性颅内动脉瘤患者的临床资料。患者中男 25 例，女 55 例；年龄 57.5 岁。其中未破裂动脉瘤 13 例，破裂动脉瘤 67 例（破裂动脉瘤中小动脉瘤占 52.2%），共 198 个动脉瘤。开颅标准采用 4cm 切口和 2.5cm 左右骨窗。48 例采用眶上锁孔入路，45 例采用翼点锁孔入路，3 例采用纵裂间锁孔入路。
双侧和单侧锁孔入路分别应用于 18 例和 62 例。共夹闭同侧 170 个和对侧 7 个动脉瘤，完全夹闭率为 98.9%。术后 6~12 个月随访时，格拉斯哥预后评分（GOS）5 分 74 例，4 分 5 例，3 分 1 例。预后与术前 Hunt-Hess 分级有关，而与手术侧数、手术时机及夹闭动脉瘤数无关。
早期锁孔手术夹闭多发性颅内动脉瘤是一种有效的治疗方法。其中破裂动脉瘤中小动脉瘤常见，需要重视并及时治疗。
