显微手术治疗颅内巨大椎动脉瘤(附15例分析)

Microsurgery treatment of the giant aneurysms of the intracranial vertebral artery: analysis of 15 cases

目的探讨颅内巨大椎动脉瘤的诊断及治疗方法。方法总结15例巨大椎动脉瘤的手术经验。瘤颈夹闭6例,椎动脉近端阻断2例,瘤壁塑形3例,孤立术3例,动脉瘤包裹1例。结果术后有13例进行了DSA和/或CTA检查,动脉瘤不显影者12例。15例患者术后1月好(GOS4～5分)10例,差(GOS2～3分)4例,死亡1例。结论手术仍为巨大椎动脉瘤的首选治疗方法。应个性化设计治疗方案,据术中情况合理处理动脉瘤。

Objective To analyze and discuss the diagnosis and surgical treatment on giant aneurysms of the intracranial vertebral artery. Method Operative experiences of 15 cases with vertebral artery aneurysms were retrospectively summarized. Six aneurysms were directly clipped, 2 were occluded the proximal parent artery, 3 were shaped, 3 were isolated, and 1 was wrapped. Results Postoperative DSA and/or CTA were taken in 13 patients, showing that the aneurysms were disappeared in 12 cases. At one month after operatin good outcome （GOS score of 4 or 5） was achieved in 10 patients, poor （ GOS score of 2 or 3 ） in 4, and death in 1. Conclusions Individualized neurosurgical therapy is the first choice for treatment of giant aneurysms of the intracranial vertebral artery, which based on findings during operation .