显微外科手术治疗颅内后循环动脉瘤(附21例分析)

Microsurgery for Intracranial Aneurysms of Posterior Circulation

目的总结颅内后循环动脉瘤的临床特点、手术时机、手术入路选择及手术注意要点。方法我院2005年以来收治的颅内后循环动脉瘤21例(共26个动脉瘤),其中基底动脉分叉部动脉瘤4例(1例同时伴有前交通动脉瘤),大脑后动脉瘤5例(1例P2和P3段各有1动脉瘤),小脑上动脉瘤2例,小脑后下动脉瘤7例(同时伴左侧眼动脉瘤、大脑中动脉瘤、颈内动脉C5段动脉瘤各1例),椎动脉瘤3例。手术治疗18例,栓塞治疗2例,1例手术麻醉过程中死亡。结果按GOS评分评定预后,18例预后好,2例差(轻残)。结论后循环动脉瘤大多瘤体较大,瘤内多有血栓形成。手术治疗需要选择合适的手术入路,以便充分显露动脉瘤和载瘤动脉。应根据病人的术前Hunt-Hess分级以及动脉瘤的部位、大小、形态和医院的设备条件,选择个体化的治疗方法,方可取得较为满意的治疗效果。

Objective To summarize the clinical features and operative occasions, approaches and key points in the patients with the intracranial aneurysms of posterior circulation. Methods The clinical data of 21 patients with posterior circulation aneurysms who were treated in our hospital were analyzed retrospectively. Of 26 aneurysms in 21 patients, 4 aneurysms were at the basilar apexes, 6 in the posterior cerebral arteries, 2 in the superior cerebellar arteries, 7 in the posterior inferior cerebellar arteries, 3 in the vertebral arteries, 1 in the anterior communicating artery, 1 in the left ophthalmic artery, 1 in the left middle cerebral artery and 1 in the intracranial segment of the left internal carotid artery. Results Eighteen patients underwent microsurgery, and 2 did endovascular embolization. The outcomes were excellent or good in 18 patients, 2 were middle disabled, and 1 died of anesthesia. Conclusions The posterior circulation aneurysms are of characteristics including the larger aneurysmal body, intraaneurysmal thrombus and so on. A proper surgical approach should be selected to expose aneurysm and its parent artery clearly. Individual treatment strategies should be applied to the different patients according to the aneurysmal location, size, shape, preoperational Hunt ＆ Hess Grade, and the condition of the hospital. By this way, the satisfactory outcomes can be achieved in the patients with posterior circulation aneurysms.