经枕下旁正中入路手术治疗小脑后下动脉近端动脉瘤16例

Microsurgery through paramesial suboccipital approach for proximal posterior inferior cerebellar artery aneurysms

目的探讨小脑后下动脉近端动脉瘤的临床特点及手术方法。方法回顾性分析16例小脑后下动脉近端动脉瘤的临床特点、影像学特征、手术治疗方法及预后。14例为破裂动脉瘤;2例为未破裂动脉瘤,表现为后颅窝占位。入院时患者Hunt-Hess分级:0级2例,Ⅱ级10例,Ⅲ级3例,Ⅳ级1例。头颅CT表现为天幕下为主的蛛网膜下腔出血和/或第四脑室出血,脑血管造影提示小脑后下动脉近端动脉瘤,均采用枕下旁正中入路进行手术。14例行动脉瘤颈夹闭术,2例行孤立术。结果 3例术后出现切口一过性脑脊液漏;2例轻度后组颅神经受损,3个月后完全恢复。随访3个月至2年,2例孤立术患者术后偏瘫、后组颅神经麻痹和长期昏迷;其余患者术后恢复良好。结论熟悉小脑后下动脉瘤区域的解剖关系,术中对后组颅神经和小脑后下动脉的有效保护,可明显提高小脑后下动脉近端动脉瘤的手术治疗效果。

Objective To explore the clinical characteristics and surgical management of proximal posterior inferior cerebellar artery （PICA） aneurysms. Methods The clinical data of 16 patients with proximal PICA aneurysms, of whom, 14 had ruptured aneurysms and 2 unruptured ones, were analyzed retrospectively, including the clinical and imaging characteristics, surgical method and prognoses. Of 16 patients with proximal PICA aneurysm in whom the microsurgery through the paramesial suhocciptal approach was performed, 14 underwent clipping of the aneurysms and 2 trapping of the aneurysms. Results Transient CSF leak occurred in 3 patents after the surgery. The postoperative mild lower cranial nerve paresis in 2 patients was cured within 3 months after the surgery. The following-up from 3 months to 2 years showed that 14 were recovered well, and 2 suffered from the lower cranial nerve palsy and long-term coma. Conclusion The curative effect of microsurgery on the proximal PICA aneurysms may be enhanced by protecting the low cranial nerves and PICA.