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两侧脑动脉瘤手术时,首先应该处理破裂的动脉瘤,然后最理想的是在同一术野中夹闭对侧未破裂动脉瘤,这样对患者损伤小。对于脑底动脉环半侧的动脉瘤(颈内动脉、前交通动脉、大脑中动脉和脑底动脉分叉部附近的动脉瘤)加上对侧颈内动脉瘤(颈-眼动脉、颈-后交通动脉、颈-脉络膜前动脉和颈内动脉分叉部动脉瘤等),如果适当选择病例,从一侧翼点入路夹闭对侧颈动脉瘤是可能的。作者报告了2例。一例为右侧大脑中动脉瘤加左侧颈-后交通动脉瘤;另一例为左侧颈-后交通动脉瘤加右侧颈-脉络膜前动脉瘤。这两例均由一侧翼点入路,处理了同侧动脉瘤后,在同一术野中夹闭了对侧动脉瘤的瘤蒂。本文主要探讨手术入路问题并报告了病例。
On both cerebral aneurysm surgeries, the ruptured aneurysm should be treated first, and then ideally, the contralateral unruptured aneurysm should be clipped in the same surgical field. This will result in less damage to the patient. For aneurysms of the cerebral aortic ring hemisphere (anterior carotid arteries, anterior communicating arteries, middle cerebral arteries, and aneurysms near the bifurcation of the cerebral artery) plus contralateral internal carotid aneurysms (cervical-ocular arteries, necks- Posterior communicating arteries, anterior cervical-choroidal artery, and internal carotid artery bifurcation aneurysms, etc.) If appropriate cases are selected, it is possible to clip the contralateral carotid aneurysm from the side-flap approach. The author reported 2 cases. One case was a right middle cerebral artery aneurysm plus a left cervical-posterior communicating artery aneurysm; the other was a left cervical-posterior communicating artery aneurysm plus a right cervical-choroidal aneurysm. Both cases were treated with a side-flap point and treated with ipsilateral aneurysms. The pedicles of contralateral aneurysms were clipped in the same surgical field. This article focuses on surgical approaches and reports cases.