Clinical Study on Surgical Treatment of Bilateral Multiple Intracranial Aneurysms through Unilateral Pterional Approach
|Keywords||intracranial aneurysm multiple bilateral microsurgical unilateral approach|
Objective:To clinically analyze preoperative assessment, case selection, operation method and the merit and demerit of treatment of bilateral multiple intracranial aneurysms through unilateral pterional approach.Methods:Retrospectively analyzed clinical data of57patients with bilateral multiple intracranial aneurysms from June2008to March2013in our hospital.15cases adopted the treatment of unilateral pterional approach to clip double sides of intracranial aneurysms in one-stage microsurgery(Group A), and27cases were treated double sides of intracranial aneurysms through bilateral pterional approach in one-stage or two-stage microsurgery(Group B). All the patients were below Ⅲ according to Hunt-Hess grading. Patients of Group A had total of34aneurysms. The number of the patients combining with bifurcation of ICA aneurysm of contralateral duty aneurysm was2, and OA aneurysm was1, PCoA aneurysm was4, MCA aneurysm was7, ACA aneurysm was1. Patients of Group B had total of58aneurysms, including of29of MCA aneurysms (3of M1segment,25of M1bifurcation,1of M2),20of PCoA aneurysms,3of AchoA aneurysms,1of OA aneurysm,3of ACA aneurysms,1of bifurcation of ICA aneurysm,1of BAA aneurysm. After fully preoperative assessment of all patients, patients of Group A adopted unilateral pterional approach to clip the duty aneurysm at first, and followed the order from easy to difficult to clip bilateral aneurysms. The patients of Group B was clipped the ipsilateral aneurysm through pterional approach of duty aneurysm side. And according to the patient’s condition, the contralateral aneurysm would be clipped through contralateral pterional approach in one-stage or two-stage.Results:34aneurysms were clipped well in15cases of Group A, and57aneurysms were clipped well in27cases of Group B. Patients of two groups were reexamined with DSA or CTA and the result showed that all bilateral multiple aneurysms were clipped completely and load tumor vessels were open. After average2-6months of postoperative follow-up prognosis of all cases were good and no death case happened.Conclusion:Clipping bilateral multiple intracranial aneurysms through unilateral pterional approach has the advantage of little damage, short operation time and avoiding the secondary operation. And this surgical method is one of reliable and effective procedures in treating bilateral multiple intracranial aneurysms.