Effect analysis of pterional approach combined with partial orbital roof and zygomatic process resection for the treatment of ruptured anterior communicating artery aneurysms
10.3969/j.issn.1672-5921.2017.02.008
- VernacularTitle:翼点入路联合部分眶顶和额骨颧突切除治疗前交通动脉破裂动脉瘤的效果分析
- Author:
Sheng LIU
;
Tao ZHANG
;
Wenbo GAO
;
Jun XU
;
Zefu LI
;
Jianmin LI
- Keywords:
Intracranial aneurysms;
Subarachnoid hemorrhage;
Orbitopterional approach;
Cognition disorders
- From:
Chinese Journal of Cerebrovascular Diseases
2017;14(2):98-102
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effect of using pterional approach combined with partial orbital roof and zygomatic process resection (modified orbitopterional approach)for the management of ruptured anterior communicating artery aneurysms. Methods From October 2013 to October 2016,36 consecutive patients with ruptured anterior communicating artery aneurysm admitted to the Department of Neurosurgery,Binzhou Medical University Hospital were enrolled retrospectively. They were all confirmed by DSA or CT angiography. The orbitopterional approach was used,only part of the orbital roof was removed and the structures of lateral orbital wall and the wings of sphenoid bone were not removed. The clinical manifestations,imaging data,surgical methods,and surgical results of ruptured anterior communicating artery aneurysms were summarized. Results All 36 patients with anterior communicating artery aneurysm in this group were treated with the modified orbitopterional approach. There was no obvious brain retraction injury on CT scan after procedure. At the time of discharge,the Glasgow outcome scale score was 5 in 25 cases, 4 in 8 cases,and 3 in 3 cases. No patients died. The patients were followed up for 3 to 24 months;no rebleeding and recurrence were observed. No complications occurred,such as enophthalmos,damage to the eyeballs, and cranial nerve injury. Conclusion The modified orbitopterional approach increased the operation space,avoided the distraction of brain tissue,significantly shortened the operation distance,and increased the deep observation angle through the removal of part of the orbital roof and the zygomatic process. It is suitable for the treatment of anterior communicating artery aneurysms,especially the rear direction,upper direction and high positioned aneurysms. There was no bone loss in the procedure,no need for orbital roof reconstruction. The gyri rectus was retained anatomically,and it may be helpful to protect the postoperative cognitive function of the patients.
