探讨大脑中动脉（MCA）镜像动脉瘤的临床特征、CT血管造影（CTA）的诊断价值及显微外科手术的治疗效果。

回顾分析解放军第二六四医院及解放军第二五一医院神经外科自2007年1月至2016年12月收治的15例经64排螺旋CTA诊断、显微外科手术治疗的MCA镜像动脉瘤患者的临床资料。CTA共检出动脉瘤32个（含2个后交通动脉瘤），MCA镜像动脉瘤均位于MCA分叉部。采取早期与择期、一期与分期相结合的方法处理MCA镜像动脉瘤，原则是先处理破裂动脉瘤，再处理未破裂动脉瘤。

一期手术9例，夹闭动脉瘤20个（含2个后交通动脉瘤），其中4例同时清除脑内血肿。二期手术4例，第一次手术夹闭动脉瘤4个，其中2例同时清除脑内血肿，第二次手术夹闭动脉瘤4个。一侧动脉瘤夹闭后，另一侧动脉瘤未处理2例。依据GOS评分判断，5分为恢复优良（10例），4分为轻度残疾（4例），3分为重度残疾（1例）。

CTA诊断MCA镜像动脉瘤准确、可靠，将MCA镜像动脉瘤分为Ⅰ型（完全对称型）和Ⅱ型（不完全对称型）有助于术前判断破裂出血的责任动脉瘤。显微外科手术是治疗MCA镜像动脉瘤的有效、可靠方法。

To study the clinical characteristics and the diagnostic value of the computed tomography angiography (CTA) and the effects of microneurosurgical management for the mirror-image aneurysm of middle cerebral artery (MCA).

The clinical data of 15 cases with mirror-image aneurysms of MCA which by 64 rows helical CTA diagnosed and underwent microneurosurgical operation were analysed retrospectively. A total of 32 aneurysms (including 2 posterior communicating aneurysms) were detected by 64 rows helical CTA and all the mirror-image aneurysms located in MCA bifurcation. The mirror-image aneurysms of MCA were treated through the method of combining early-stage with select-stage operation and one-stage with two-stage operation. The operating principle was the ruptured aneurysm performed treated first and the unruptureed aneurysm performed treated second.

Nine cases performed one-stage operation and 20 aneurysms were clipped (including 2 posterior communicating aneurysms), in which 4 cases intracerebral hematomas were removed in the same time. 4 cases performed two-stage operation and 4 aneurysms were clipped at first, in which 2 intracerebral hematomas were removed in the same time, and 4 aneurysms were clipped at second operation. One side aneurysm was clipped and another side aneurysm did not treat in 2 cases. Acording GOS scale to jude: 5 points, surgical outcome were good in 10 cases; 4 points, light disability in 4 cases and 3 points, severe disability in 1 case.

The 64 rows helical CTA is a accuracy and reliable examinational method for detecting the mirror-image aneurysm of MCA. It can help to determine the responsibility aneurysm of ruptured aneurysms if the mirror-image aneurysm of MCA had been divided into Ⅰ model (perfectly symmetry model) and Ⅱ model (in perfectly symmetry model). The microneurosurgery was the effective and reliable method to treat the mirror-image aneurysm of MCA.