【摘要】 目的 总结基层医院开展颅内动脉瘤显微外科手术的经验。方法 回顾分析了近3年对高血压性脑出血和慢性硬膜下积液病人侧裂及鞍区的显微解剖资料及颅内动脉瘤治疗的资料。结果 通过鞍区及侧裂显微手术实践，基本掌握了鞍区解剖知识和侧裂分离技术。39例颅内动脉瘤病人中，25例恢复正常工作，9例轻残，2例重残需人照料，术后死亡3例(占7.6%)。术后脑积水4例。结论 熟悉鞍区显微解剖知识和侧裂分离技术对于基层医院开展颅内动脉瘤显微外科手术是非常重要的。
【关键词】 颅内动脉瘤 显微外科手术 治疗
CLINICAL EXPERIENCE OF MICROSURGERY FOR INTRACRANIAL ANEURYSM AT PRIMARY LEVEL HOSPITALS ZHANG SHUREN, WANG QI(Department of Neurosurgery, Pingdu Peoples Hospital, Pingdu 266700, China) [ABSTRACT]ObjectiveTo summarize the experience of doing microsurgery for intracranial aneurysm at primary level hospitals.MethodsThe clinical data of hypertensive intracerebral hemorrhage (HICH) and microanatomy in Sella region and sylvian fissures in patients with chronic subdural effusion as well as the treatment of intracranial aneurysm in the last three years were analyzed retrospectively. ResultsThe knowledge of microanatomy in the Sella and dissection techniques in sylvian fissures were obtained through microsurgical practice. Of 39 patients with intracranial aneurysm treated, 25 returned to normal work, nine were mild disability, two severe disability. Three died after operation. Postoperative hydrocephalus occurred in four. Conclusion Having an intimate knowledge of microanatomy in the Sella and skill of dissection of sylvian fissures is crucial to carrying out microsurgery for intracranial aneurysm at grassroots hospitals.
[KEY WORDS]intracranial aneurysm; microsurgery; therapy
自2002年以来，我院开展了显微技术的临床研究，同时借鉴国内外的先进经验，将这一研究用于临床治疗颅内动脉瘤，并取得满意效果，现报告如下。
1 资料和方法
1.1 一般资料
39例病人，男24例，女15例;年龄为46～76岁，平均61岁。术前病情分级(Hunt):Ⅰ级11例，Ⅱ级14例，Ⅲ级12例，Ⅳ级2例。后交通动脉瘤18例(其中2例为双侧后交通动脉瘤)，前交通动脉瘤15例，大脑中动脉瘤6例。
1.2 颅内动脉瘤的临床治疗
1.2.1 鞍区及侧裂的显微解剖 对45例高血压性脑出血病人经侧裂入路行血肿清除手术，术中在显微镜下分离部分外侧裂池，进而解剖出大脑中动脉第二段(M2)及其分支和岛叶，直达血肿腔;对37例外伤性慢性硬膜下积液病人行颅底脑池开放手术，术中在显微镜下将颅底脑池(侧裂池、颈内动脉池、视交叉池、环池)打通1～2处[1]。手术时可见到视神经、视交叉、颈内动脉、大脑前动脉第一段(A1)、大脑中动脉第一段(M1)及其分支，偶尔可见到后交通动脉、脉络膜前动脉。
1.2.2 影像学检查 本组病例均行CT平扫检查，均显
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