目的 探讨显微手术治疗破裂大脑中动脉动脉瘤（MCAA）的适应证、术前评估及手术技巧。 方法 回顾性分析2008年1月－2011年1月经翼点入路行显微外科手术治疗的65例破裂MCAA患者的临床资料。其中男40例，女25例；年龄22～78岁，平均46.8岁。术前Hunt-Hess分级：Ⅰ级15例，Ⅱ级25例，Ⅲ级13例，Ⅳ级10例，Ⅴ级2例。动脉瘤直径＜5 mm 10个，5～15 mm 36个，15～25 mm 15个，＞25 mm 4个，平均7.8 mm。其中56例动脉瘤位于大脑中动脉分叉部，5例位于大脑中动脉的M1段，4例位于分叉后M2段。 结果 手术夹闭动脉瘤60例，余5例行动脉瘤夹闭加包裹术。患者术后获随访3～36个月，平均16个月，均无动脉瘤复发或再出血发生。按格拉斯哥预后评分（GOS）结果评定：恢复良好58例（GOS 4～5分），差5例（GOS 2～3分），死亡2例（GOS 1分）。 结论 充分的术前评估，合适的手术入路选择，以及手术技巧的灵活应用是显微外科手术成功治疗破裂MCAA的保证。
【摘要】 目的 研究改良Paine点侧脑室额角穿刺的解剖基础及临床应用。 方法 利用MRI模型的构建，模拟改良Paine点穿刺侧脑室额角。测量穿刺距离、角度及其对Broca语言功能区和尾状核的影响。改良Paine点（Pm点）比Paine点高1 cm，更加远离Broca语言功能区，穿刺时需要与轴面夹角20°向下，可以越过尾状核头从侧脑室额角上壁进入脑室；与矢状面夹角约70°向下、冠状面夹角约20°向后穿刺。从皮层计算进针4.0~5.5 cm可进入侧脑室额角。 结果 同期7例颅内动脉瘤患者术中应用Pm点穿刺成功，术后无语言功能障碍，复查头颅CT无穿刺道及尾状核头出血现象。 结论 Pm点法定位方法简便准确，能避免Broca语言功能区和尾状核头部的损伤，有一定临床应用推广价值。【Abstract】 Objective To analyze the anatomic characteristics and clinical application of modified Paine entry point (Pm) for lateral ventricular puncture through pterional approach. Methods We simulated the modified Paine entry point for lateral ventricular frontal horn puncture by reconstructing the model of MRI. Distance and angles of the puncture path were measured to evaluate the influence upon the language areas of Broca and the head of the caudate nucleus. The Pm point is 1 cm higher than the Paine point, so it is more far away from the Broca area. The direction of the puncture path should be 20° downward with the axial plane, 70° downward with the sagittal plane and 20° backward with the coronal plane. The catheter was inserted into the ventricle 4.0 to 5.5 cm deep to the cortex. Results Seven patients with intracranial aneurysms underwent ventricular puncture successfully through the Pm point in operation. None of them suffered language dysfunction or hemorrhage lesions in the caudate nucleus by the computed tomography. Conclusion The modified Paine entry point can be located accurately and has the clinical value for preventing damage of the Broca area and the caudate nucleus.
【摘要】 目的 探讨基层医院显微外科手术治疗动脉瘤性蛛网膜下腔出血（aSAH）的手术时机、方法以及疗效。 方法 回顾分析2005年1月-2009年12月经翼点入路行显微外科手术治疗的36例aSAH患者的临床资料。 结果 所有aSAH患者经数字减影血管造影检查确诊，均行瘤颈夹闭术。手术效果按GOS评分，恢复良好30例（83%）、中度残疾4例（11%）、死亡2例（6%）。 结论 aSAH按Hunt-Hess分级为Ⅰ～Ⅱ级的患者应尽早手术， Ⅲ～Ⅳ级应结合患者颅内出血量及全身状况综合考虑，Ⅴ级待病情稳定后积极手术治疗。经翼点入路显微外科手术治疗前循ASAH，手术中暴露清楚，夹闭瘤颈可靠，疗效满意。【Abstract】 Objective To explore the operative time, methods and curative effect of microsurgical treatment on aneurysmal subarachnoid hemorrhage (aSAH) in basic-level hospitals. Methods The data of 36 patients with aSAH who had undergone microsurgery from January 2005 to December 2009, were retrospectively analyzed. Results All the patients were confirmed as aSAH by digital subtraction angiography, and all of them had undergone clapping of aneurism. According to GOS, 30 patients (83%) had good recovery, four patients (11%) had moderate disability and two patients (6%) died. Conclusions The operation should be done as early as possible in the patients with gradeⅠ-Ⅱ of Hunt-Hess, the volume of intracranial hemorrhage and patient’s condition should be considered to decide when to operate of grade Ⅲ-Ⅳ, patients with grade Ⅴ aneurysms should be treated by conservative therapy first. They should consider an operation only when their condition is stable after conservative therapy. The peritoneal approach is a good procedure because of clear exposure, reliable clipping and satisfactory results.