颅内后循环动脉瘤的显微手术

Microsurgical operation for intracranial aneurysms of posterior circulation

目的 回顾性分析颅内后循环动脉瘤的临床表现和手术入路。 方法 后循环动脉瘤２０ 例，占同期颅内动脉瘤的９３ ％ ，其中大脑后动脉瘤１２ 例，基底动脉瘤６ 例，小脑前下动脉和小脑后下动脉瘤各１ 例。１６ 例经显微手术，主要经翼点入路和颞下经小脑幕入路。 结果 动脉瘤夹闭加切除８ 例，孤立加切除６ 例，包裹２ 例，血管内治疗２ 例，２ 例未治。１６ 例优良，２ 例轻残，无手术死亡。 结论 后循环动脉瘤大多瘤体较大，瘤内多含血栓。翼点入路对基底动脉远端、大脑后动脉 Ｐ１ ～２ 段动脉瘤显露优良，颞同步入路用于夹闭大脑后动脉 Ｐ２ ～３ 段动脉瘤。

Objective The purposes of this study was intended to retrospectively evalute the clinical features and surgical approaches of the intracranial aneurysms of posterior circulation Methods Twenty vertebrobasilar aneurysms were treated in our department through 1979 and 1996 Two surgical approaches including the pterional and the subtemporal approach were adopted Of all intracranial aneurysms 20 vertebrobasilar artery aneurysms accounted for 9 3%,of which posterior cerebral artery 12 cases,basilar artery 6 cases,anterior inferior cerebellar artery and posterior inferior cerebellar artery 1 case,respectively There was subarachnoid hemorrhage(SAⅡ) in 13 cases(65 0%) It was operated on by microsurgery in 16 cases Aneurysm embolozation was carried out in 2 cases and no treatment in the remaining 2 cases Results Sixteen cases were excelent or good,2 mildly sidable,and there was no mortality Conclusions The vertebrobasilar aneurysms tended to be large insize,to thrombose and present with compression symptoms of the brain stem and cranial nerves The pterional approach could be avaliable to expose the distal basilar PCA superior cerebellar artery and P 1～P 2 segment aneurysms,and the subtemporal approach for P 1～P 3 aneurysms