未破裂动脉瘤的显微手术治疗的临床分析
Surg Neurol. 2007 May;67(5):457-64; discussion 464-6. Epub 2007 Feb 15. Microsurgical treatment of unruptured intracranial aneurysms. A consecutive surgical experience consisting of 450 aneurysms treated in the endovascular era.Nussbaum ES, Madison MT, Myers ME, Goddard J.
Healtheast Neurovascular Institute, St Joseph's Hospital, St Paul, MN 55102, USA. [email]lnussbaum@mn.rr.com[/email] [email]lnussbaum@mn.rr.com[/email]
BACKGROUND: With the progressive refinement of endovascular techniques, fewer IAs are being treated with open microsurgery. There is limited information regarding the impact of this trend on the ability of younger neurosurgeons to achieve proficiency in the surgical management of IAs. We describe a consecutive series of patients with unruptured IAs treated by a neurosurgeon initiating a dedicated cerebrovascular practice in the "endovascular era." METHODS: We retrospectively reviewed the records of all patients who had undergone surgical repair of a saccular IA by one neurosurgeon upon completion of neurosurgical training in July 1997 until April 2005. Patients with ruptured IAs were excluded from review. RESULTS: Of the 1450 patients with IAs treated during this period, 376 underwent microsurgical repair of 450 unruptured IAs. Microsurgical aneurysm neck clipping was possible in most cases, although distal revascularization with proximal occlusion was used in many of the more complicated aneurysms. CONCLUSIONS: Despite the growing role of endovascular therapy in the management of IAs, it is possible for young neurovascular surgeons to achieve acceptable results with open microsurgical treatment of IAs. The factors that were deemed important in achieving success in this series included a collaborative approach with endovascular colleagues, careful surgical judgment, continual reanalysis of personal results, and early support from experienced mentors.
未破裂动脉瘤的显微手术治疗的临床分析（单中心治疗的450例动脉瘤）
Nussbaum ES, Madison MT, Myers ME, Goddard J.
Healtheast Neurovascular Institute, St Joseph's Hospital, St Paul, MN 55102, USA. [email]lnussbaum@mn.rr.com[/email] [email]lnussbaum@mn.rr.com[/email]
BACKGROUND: With the progressive refinement of endovascular techniques, fewer IAs are being treated with open microsurgery. There is limited information regarding the impact of this trend on the ability of younger neurosurgeons to achieve proficiency in the surgical management of IAs. We describe a consecutive series of patients with unruptured IAs treated by a neurosurgeon initiating a dedicated cerebrovascular practice in the "endovascular era."
研究背景:随着血管内技术的不断发展和完善，越来越少的动脉瘤患者采用开颅手术。这种趋势往往限制了年轻神经外科医师对动脉瘤显微手术熟练性的提高。我们回顾性分析了该中心专门从事脑血管手术的的神经外科医师治疗的未破裂动脉瘤的资料。
METHODS: We retrospectively reviewed the records of all patients who had undergone surgical repair of a saccular IA by one neurosurgeon upon completion of neurosurgical training in July 1997 until April 2005. Patients with ruptured IAs were excluded from review.
方法：我们回顾性分析了单个医师从1997年7月－2005年4月手术处理的所有囊性动脉瘤患者的资料，资料中不包括破裂动脉瘤。
RESULTS: Of the 1450 patients with IAs treated during this period, 376 underwent microsurgical repair of 450 unruptured IAs. Microsurgical aneurysm neck clipping was possible in most cases, although distal revascularization with proximal occlusion was used in many of the more complicated aneurysms.
结果：我们收治了1450动脉瘤患者，450例为未破裂动脉瘤。未破裂动脉瘤中的376例患者采用显微手术处理。大多数患者行瘤颈夹闭，部分复杂动脉瘤行载瘤动脉近段闭塞，远段血流重建。
Major complications occurred in 6 (1.60%) patients, and 1 (0.27%) patient died. At the time of 6-month follow-up, 4 (1.06%) patients were left with a new focal neurologic deficit related to surgery.
主要并发症1.60％（6/376）,死亡率0.27%(1/376).随访6个月，手术因素导致新出现的局限性神经功能缺损1.06％（4/376）。
CONCLUSIONS: Despite the growing role of endovascular therapy in the management of IAs, it is possible for young neurovascular surgeons to achieve acceptable results with open microsurgical treatment of IAs.
结论：尽管血管内治疗越来越受到欢迎，对于年轻的神经血管医师来说，动脉瘤的显微手术可以获得满意的治疗效果。
The factors that were deemed important in achieving success in this series included a collaborative approach with endovascular colleagues, careful surgical judgment, continual reanalysis of personal results, and early support from experienced mentors.
手术成功的关键因素与血管组成员间的合作，严谨的手术判断，坚持自我反思，熟练上级医师的早期指导分不开的。
未破裂动脉瘤的显微手术治疗的临床分析（单中心治疗的450例动脉瘤）
作者略
研究背景:随着血管内技术的不断发展和完善，越来越少的动脉瘤患者采用开颅手术。这种趋势往往限制了年轻神经外科医师对动脉瘤显微手术熟练性的提高。我们回顾性分析了该中心专门从事脑血管手术的的神经外科医师治疗的未破裂动脉瘤的资料。方法：回顾性分析该医师从1997年7月－2005年4月手术处理的所有囊性动脉瘤患者的资料，资料中不包括破裂动脉瘤。结果：我们收治了1450动脉瘤患者，450例为未破裂动脉瘤。未破裂动脉瘤中的376例患者采用显微手术处理。大多数患者行瘤颈夹闭，部分复杂动脉瘤行载瘤动脉近段闭塞，远段血流重建。主要并发症1.60％（6/376）,死亡率0.27%(1/376).随访6个月，手术因素导致新出现的局限性神经功能缺损1.06％（4/376）。结论：尽管血管内治疗越来越受到欢迎，对于年轻的神经血管医师来说，动脉瘤的显微手术可以获得满意的治疗效果。手术成功的关键因素与血管组成员间的合作，严谨的手术判断，坚持自我反思，熟练上级医师的早期指导分不开的。
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