眶上正中锁孔入路治疗大脑前动脉远端破裂动脉瘤：技术报告并文献复习
MedianSupraorbitalKeyholeApproachforClippingRupturedDistalAnteriorCerebralArteryAneurysm:TechnicalReportwithReviewofLiterature
背景：由于存在与传统额部旁正中入路相关的某些困难，大脑前动脉远端（DACA）动脉瘤的微创入路尚未得到太多的认可。无论如何，更近颅底的纵裂入路都需要广泛的软组织游离。作者介绍了一种全新的微创眶上正中锁孔开颅术，配合颅底纵裂入路，可夹闭DACA破裂动脉瘤。
BACKGROUND:Theminimallyinvasiveapproachtodistalanteriorcerebralartery(DACA)aneurysmshasnotgainedmuchacceptanceduetodifficultiesassociatedwiththeconventionalfrontalparamedianapproach.Themoreproximalbasalinterhemisphericapproach,however,necessitatesextensivedissectionofsofttissues.WedescribeanovelminimallyinvasivemediansupraorbitalkeyholecraniotomywithabasalinterhemisphericapproachforclippingarupturedDACAaneurysm.
方法：患者62岁，罹患蛛网膜下腔出血。经CT血管造影确诊为DACA动脉瘤。手术技术涉及锁孔开颅术，其手术切口沿眉毛走行于两侧眶上切迹之间，并且与前颅窝平齐。经前部切开硬脑膜及大脑镰，实施纵裂解剖，以实现足够的近端控制，以及动脉瘤瘤颈的游离和夹闭。另外，还进行了相关文献的复习。
METHODS:A62-year-oldpatientpresentedwithsubarachnoidhemorrhage.ComputedtomographyangiographyrevealedaDACAaneurysm.Thesurgicaltechniqueinvolvedakeyholecraniotomymadeviaaneyebrowincisionextendingbetweenthesupraorbitalnotches,andflushwiththeanteriorcranialfossa.Thedurawasopenedattheanteriorpart,thefalxwascut,aninterhemisphericdissectionwascarriedout,adequateproximalcontrolwasobtained,andtheaneurysmneckwasdissectedandclipped.Arelevantreviewoftheliteraturewascarriedout.
结果：患者恢复良好，无动脉瘤残余或额部麻痹，并且获得了较好的美容效果。与先前所述的“单侧锁孔纵裂”入路相比，该技术遭遇桥静脉的可能性更小；经脑池脑脊液的释放更容易，即使存在脑肿胀亦可行；近端血管控制更佳；而且手术路径直指瘤颈而非瘤顶。
RESULTS:Thepatientrecoveredwell,withnoresidualaneurysmorforeheadnumbness,withgoodcosmesis.Comparedwiththepreviouslydescribed“keyholeunilateralinterhemispheric”approaches,ourtechniquehaslesslikelihoodofencounteringbridgingveins;easiercisternalcerebrospinalfluidrelease,makingitfeasibleeveninswollenbrain;betterproximalvascularcontrol;andtrajectorytowardtheneckratherthandome.
结论：眶上正中锁孔入路是一种足以夹闭大多数DACA动脉瘤的微创技术，手术进路更容易，近端控制更佳，而且美容效果较好。
CONCLUSION:ThemediansupraorbitalkeyholeapproachisaminimallyinvasivetechniquesufficientforclippingmostDACAaneurysms,witheasieraccess,betterproximalcontrol,andgoodcosmesis.
关键词：颅底纵裂，夹闭，大脑前动脉远端动脉瘤，微创，眶上锁孔
KEYWORDS:Basalinterhemispheric;Clipping;Distalanteriorcerebralarteryaneurysm;Minimallyinvasive;Supraorbitalkeyhole
原文出处：DhandapaniS,SahooSK.MedianSupraorbitalKeyholeApproachforClippingRupturedDistalAnteriorCerebralArteryAneurysm:TechnicalReportwithReviewofLiterature.WorldNeurosurg,;:73-76.
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