颅内后循环复杂动脉瘤的诊治

The diagnosis and treatment for complex aneurysms in intracranial posterior circulation

目的探讨颅内后循环复杂动脉瘤的诊断及治疗。方法回顾分析38例颅内后循环复杂动脉瘤病人资料,Hunt-Hess分级0级5例,Ⅰ级10例,Ⅱ级19例,Ⅲ级3例,Ⅳ级1例;其中开颅手术3例,介入治疗25例,介入联合开颅治疗1例,未治疗9例。结果出院时根据GOS评分:4～5分20例,2～3分15例,死亡3例。17例经3个月～1.5年随访,其中GOS4～5分12例,2～3分2例,死亡3例。结论 DSA尤其3D-DSA是诊断颅内后循环动脉瘤的金标准,颅内后循环复杂动脉瘤多以介入治疗为主,其治疗应遵循个体化原则。

Objective To explore diagnosis and treatment for complex aneurysms in intracranial posterior circulation.Methods The clinical data of 38 patients with complex aneurysms in intracranial posterior circulation were analyzed retrospectively,including grade 0 in 5 patients,grade Ⅰ in 10,grade Ⅱ in 19,grade Ⅲ in 3 and grade Ⅳ in 1 according to Hunt-Hess score.Microcraniotomy was performed in 3 patients,interventional therapy in 25,interventional therapy combined with craniotomy in 1 and no treatment in 9.Results The therapeutic effect at discharge was evaluated by Glasgow outcome scale（GOS）：4-5 in 20 patients,2-3 in 15 and 3 patients died.Seventeen patients were followed-up from 3 months to 1.5 years：GOS 4-5 in 12 cases,2-3 in 2 and death in 3.Conclusions The digital subtraction angiography（DSA）,especially three dimension-DSA（3D-DSA）,is a gold standard for diagnosis of intracranial aneurysms in the posterior circulation.The interventional therapy complying with individual principles is the main treatment for complex aneurysms in intracranial posterior circulation.