摘要
目的探讨后循环动脉瘤手术适应证和治疗效果。方法纳入42例共44个后循环动脉瘤,包括基底动脉动脉瘤26例(27个)、椎动脉动脉瘤16例(17个)。其中15例分别行颈外动脉大脑后动脉P2段(4例)、颈内动脉大脑后动脉P2段(2例)、颌内动脉大脑后动脉P2段(2例)、椎动脉颅内外段(2例)、枕动脉小脑后下小动脉(5例)搭桥联合动脉瘤孤立术;余27例行单纯动脉瘤夹闭术。结果经随访共37例(基底动脉顶端动脉瘤14例、基底动脉主干动脉瘤3例、椎动脉动脉瘤9例、小脑后下动脉动脉瘤5例、大脑后动脉P1～P2段交界处动脉瘤4例、小脑上动脉动脉瘤1例和小脑前下动脉动脉瘤1例)患者恢复正常生活活动能力,无一例发生手术相关性神经功能障碍,恢复良好率达88.09%。其余5例患者,1例(基底动脉顶端动脉瘤)术后出现严重神经功能缺损症状与体征,生活不能自理;2例(1例基底动脉顶端动脉瘤、1例基底动脉主干动脉瘤)因术后发生脑干缺血,围手术期死亡;2例(椎动脉动脉瘤)复发患者经再次治疗康复。结论对于不宜直接行手术夹闭的后循环动脉瘤,为了避免因夹闭动脉瘤和延长临时阻断载瘤动脉时间而发生术后脑缺血事件,可选择颅内外血管搭桥联合动脉瘤孤立术,以避免动脉瘤夹闭术带来的危险。
Objective To retrospectively analyze effective methods for surgical management of posterior circulation aneurysms. Methods There were 42 patients with posterior circulation aneurysms [26 cases of basilar aneurysm （27 aneurysms）, 16 cases of vertebral aneurysm （17 aneurysms）]. There were 15 patients underwent bypass surgery [4 external carotid artery P2 segment of posterior cerebral artery （ECA P2）, 2 internal carotid artery P2 segment of posterior cerebral artery （ICA P2）, 2 internal maxillary artery P2 segment of posterior cerebral artery （IMA P2）, 2 intracranial segment of vertebral artery extracranial segment of vertebral artery, 5 occipital artery posterior inferior cerebellar artery （OA PICA）] and 27 patients underwent simple surgical clipping. Results Activities of daily life of 37 patients recovered to normal （14 patients with aneurysm on the top of basilar artery, 3 with aneurysm on the trunk of basilar artery, 9 with vertebral aneurysm, 5 with posterior inferior cerebellar artery aneurysm, 4 with aneurysm on the junction of P1-P2 segment of posterior cerebral artery, 1 with superior cerebellar artery, and 1 with anterior inferior cerebellar aneurysm）. None of them occurred operation related neurological dysfunction. The recovery rate was 88.09% . Among the other patients, 1 with aneurysm on the top of basilar artery presented severe signs and symptoms of neurological defect and cannot take care of oneself, 2 patients （1 with aneurysm on the top of basilar artery, 1 with aneurysm on the trunk of basilar artery） occurred brain stem hemorrhage after operation, and died at perioperative period, 2 with vertebral aneurysm relapsed and was cured after treatment. Conclusion Posterior circulation aneurysm which is not suitable for surgical clipping can be treated with intra and extra cranial vessel bypass. It may avoid the risk of surgical clipping of aneurysm.
出处
《中国现代神经疾病杂志》
CAS
2012年第1期48-54,共7页
Chinese Journal of Contemporary Neurology and Neurosurgery
关键词
颅内动脉瘤
脑血管重建术
蛛网膜下腔出血
椎动脉
基底动脉
Intracranial aneurysm
Cerebral revascularization
Subarachnoid hemorrhage
Vertebral artery
Basilar artery
