| Objective:To study the relationship between the loaction and size of anterior communicating artery aneurysm and rupture. Analyzing timing of surgery and surgical techniques are in effect on postoperative complications after treatment.Methods:Retrospected and summarized the 82 clinical cases of microsurgical treatment for anterior communicating artery’aneurysm via pterional approach, that from the First Affiliated Hospital of Kunming Medical University of minimally invasive neurosurgery (from October 2008 to December 2014). Patients age from 15 to 78 years old (average 49.78±11.96 years old), the most field of age is 40 to 59 years old; In which, have 40 patients are male, others are women,the proportion of male and female is 0.95:1; Have 52 people diagnosed by whole brain DSA, others by brain CTA; they can be divided into groups by Hunt-Hess illness grading(0 stands for the patients of unruptured aneurysms, I-V stand for patients of SAH), in this way,0 lever has 11 cases, I lever has7 cases, II lever has 30 cases, Ⅲ lever has 25 cases, Ⅳlever has 8 cases, V lever has 1 cases. SAH patients in early (≤3d)surgery have 21 cases, the medium-term (4d-2W) suegery have 15 cases, delayed(>2W) surgery have 35 cases. All the cases were treated by pterional approach for.Microsurgical clipping an aneurysm, the one who has greater aneurysm received resection of the tumor, and puncture or cut remove blood clots to shrink tumors, the patients of ventricular system hemorrhage and mild hydrocephalus underwent ostomy of endplate pool, the brain severe swelling received decompressive craniectomy. After operation, patients were treated with hypertension, high blood volume, high hemodilution therapy and calcium antagonist Nimodipine for treatment. Efficacy was evaluated by GOS grading standards when the patient was discharged.Results:By DSA, CTA and intraoperative findings,82 patients were found have 85 anterior communicating artery aneurysm, which from the bottom of the anterior cerebral artery and anterior communicating artery A2 segment angles have 51(60%), 46 of them had ruptured (rupture rate was 90.2%); from the anterior communicating artery in the middle have 34(40%),25 of them ruptured (rupture rate was 73.5%). Between the 85 aneurysms,34 (40%)aneurysms are small aneurysms (diameter of tumors< 5 mm),27 of them had ruptured (rupture rate was 79.4%); 42 (49.4%)aneurysms are normal aneurysm (diameter of tumors was 5～15 mm),36 of them ruptured (rupture rate was 85.7%); 8 (19.4%)are Large aneurysm (diameter> 15 tumors,< 25 mm),7 of them ruptured (rupture rate was 87.5%); 1 is giant aneurysms (diameter of tumors≥25 mm) and ruptured (rupture rate was 100%), it’s diameter is 30mm. Tumors had 27(31.8%) point to above,15(17.6%) point to below,31(36.4%) point to front,6(7.1%) point to rear,6 (7.1%)are complex points.When discharging the station of patients according to GOS scores, the good prognosis of patients with grade 0-V level rate are 90.9% 85.6%,86.7%,80.0%, 86.7% and 80.0%; Early, mid, and delayed surgery good prognosis rate are 85.7%, 73.3% and 85.7%. What’s more, all good prognosis rate was 79.3%(65 cases), mild disability rate is 12.2%(10 cases), severe disability rate is 3.7%(3 cases), no vegetative state, the death rate was 4.9%(4 cases).Conclusion:1.The aneurysm from the bottom of the anterior cerebral artery and anterior communicating artery A2 segment angles, and the diameter of tumor<5mm of anterior communicating artery aneurysm rupture easily, so we should gave actively preventive intervention treatment.2. when we have operation conditions, no matter what the garding level of anterior communicating artery aneurysm is, we should actively strive for early surgery.3. Pterion approach exposed clear operation field, can meet an aneurysm clipping for tumors that have different point, and can clip tumor neck reliablely. In a word, It is a is a kind of easy, effective and reliable method, and it cause less postoperative complications, so it is worth promoting.4. Master micromanipulation technique and microscopic anatomy knowledge is the key to successful operation. |
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