摘要
目的探讨后交通动脉动脉瘤(PCo AA)合并动脉圆锥的影像特点及开颅夹闭术中的处理体会。方法回顾性分析2012年1月至2016年1月湖北省新华医院神经外科收治的PCo AA合并动脉圆锥45例患者的病历资料,分析术中动脉瘤夹闭方式,以及对动脉圆锥的处理方式。结果 45例患者术前3D-DSA均显示PCo AA合并动脉圆锥,动脉圆锥呈漏斗样,与动脉瘤共基底,位于颈内动脉近心端下前侧,动脉瘤则位于颈内动脉远心端外后侧,圆锥顶端有细小后交通动脉(PCo A)显影,圆锥最大径<3 mm。术中显微镜下所见与DSA检查一致,残存的PCo A血供极少,血管变细,外观较正常动脉颜色稍浅。当瘤颈较宽时,动脉圆锥基底亦增宽,圆锥深度浅,结构不典型,瘤颈较窄时,圆锥结构较为典型。术中动脉瘤瘤颈连同动脉圆锥共同夹闭18例,术后无脑缺血发生;保留PCo A及动脉圆锥夹闭动脉瘤27例,随访期内无再出血及动脉瘤形成或复发。结论 PCo AA合并动脉圆锥具有一定的影像学特点,术中应根据动脉瘤瘤颈夹闭难易程度、瘤颈与动脉圆锥共生关系及后循环供血情况等因素决定是否保留PCo A。
Objective To investigate the imaging features of posterior communicating artery aneurysms (PCoAA) complicated with conus arteriosus and the treatment experience of craniotomy clipping. Methods The medical records of 45 patients with PCoAA complicated with conus arteriosus admitted to the Department of Neurosurgery, Hubei Xinhua Hospital from January 2012 to January 2016 were analyzed retrospectively. The intraoperative aneurysm clipping methods and treatment methods for conus arteriosus were analyzed. Results The preoperative three-dimensional digital subtraction angiography(3D- DSA)of 45 patients showed PCoAA complicated with conus arteriosus. The conus arteriosus showed infundibulform and sharing the same neck with the aneurysm. It was located in the proximal end lower-front side of the internal carotid artery, and the aneurysm was located in the distal end of outer rear side of the internal carotid artery. There was a tiny posterior communicating artery development at the top of conus arteriosus. The maximum diameter of conus arteriosus was less than 3 rnm. The intraoperative microscope findings were consistent with those of DSA. The residual posterior communicating artery blood supply was very few,the blood vessels became thin,and the color of the appearance of arteries was slightly lighter than that of the normal arteries. When the neck of aneurysm was wider, the base of conus arteriosus also widened. The color of conus arteriosus was light,the structure was not typical. When the neck of aneurysm was narrower, the structure of eonus arteriosus was typical. Intraoperative aneurysm necks together with the conus arteriosus of the posterior communicating arteries were clipped in 18 cases, no cerebral ischemia occurred after operation;the posterior communicating arteries and conus arteriosus were retained, the aneurysms of 27 patients were clipped. No rebleeding and aneurysm formation or recurrence was observed within the follow-up period. Conclusions PCoAA complicated with conus arteriosus has a certain
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2016年第8期427-430,共4页
Chinese Journal of Cerebrovascular Diseases
关键词
后交通动脉动脉瘤
动脉圆锥
影像学
夹闭术
Posterior communicating artery aneurysms
Conus arteriosus
Imaging
Clipping