33例椎-基底动脉瘤的临床观察

The clinical review of vertebral basilar artery aneurysm in 33 cases

目的：探讨椎－基底动脉瘤治疗方法与预后关系。材料与方法：报告３３例椎－基底动脉瘤。动脉瘤破裂致ＳＡＨ１８例，动脉瘤直径从５ｍｍ到４５ｍｍ。其中９例行保守治疗。直接手术治疗中，９例夹闭术，２例瘤壁加固术。１３例行血管内栓塞治疗。结果：９例保守治疗中３例因再次出血死亡。１１例直接手术均痊愈。１３例血管内栓塞治疗后１～３个月后复查造影，闭塞率＞８０％者１２例。结论：椎－基底动脉瘤积极手术治疗可降低死亡率，依动脉瘤部位与大小采用不同手术入路至关重要，血管内栓塞治疗适于直接手术难以达到者，疗效肯定。

Objective: To study the relationship between treatment and prognosis of vertebral basilar artery aneurysm. Methods: Thirty three cases of vertebral basilar aneurysm located at basilar artery trunk, bifurcation, middle and inferior parts of basilar artery or vertebral artery were reported. There were 18 cases of SAH due to rupture of aneurysm which the diameters in size ranged from 5 to 45mm. Among 33 cases, 9 cases were treated conservatively, 11 cases were operated with clipping or wrapping of aneurysm respectively 13 cases were treated with endovascular therapy. Results: 3 patients in conservative group died from further hemorrhage and 11 patients in the operative group were recovered completely. The emboric rate in 12 patients of 13 cases documented by angiography 1～3 months after operation was larger than 80% in the endovascular therapy group. Conclusion: It is very important to select different approach according to the location and size of aneurysm. Although the operation can obviously decrease mortality of vertebral basilar artery aneurysm. The endovascular therapy may be useful for the aneurysm that treate difficult with direct operation.