大脑后动脉动脉瘤的介入与外科治疗及文献回顾

The endovascular treatment and open surgery of the posterior cerebral aneurysms and the literature review

目的探讨大脑后动脉动脉瘤的临床特点及治疗策略。方法回顾性分析200 6年1月～201 2年6月明确诊断的8例大脑后动脉动脉瘤的临床特点、治疗策略及随访情况。结果 8例大脑后动脉动脉瘤中,P1～P2交界处2例,P2段4例,P3段2例。行介入手术6例(3例患者闭塞载瘤动脉,3例患者行瘤囊内弹簧圈),开颅手术2例(1例采用扩大翼点入路,1例采用颞下入路)。3例行载瘤动脉闭塞介入治疗的患者中,1例术后出现视野缺损,其余行介入治疗患者都未出现明显的并发症。开颅手术的2例患者中,1例患者术后出现血管痉挛,1例患者术后出现一过性的肢体肌力下降,经积极改善循环、营养神经及康复治疗后症状好转。术后随访GOS评分者7例,4分者1例。术后有1例患者遗留的视野缺损未能恢复。结论大脑后动脉动脉瘤常发生于P2段,以蛛网膜下腔出血常见。目前对于大脑后动脉动脉瘤的治疗多选择行血管内介入治疗,当无法行血管内介入治疗时,可行开颅手术治疗。对于一些复杂动脉瘤,常规手术难以夹闭,难以保留载瘤动脉时,可行血管吻合术以弥补远端血流不足。

Objective To investigate the clinical features and the management of the posterior cerebral artery aneurysms and review the Literature. Methods To retrospectively evalue the data of the 8 patients which we treaed between 2006.01 to 2012.06.Data relating the clinical features,the guidelines of dealing with the aneurysms,and the follow-up results. Results The aneurysms arose from the P1-P2 segment in 2 patients,from the P2 segment in 4 patients, from the P3 segment in 2 patients. 6 of 8 patients were treated with endovascular management,Open surgery were performed on 2 patients, of those who were treated with endovascular management, 3 patients were treated with parent artery occlusion, 3 patients were treated with endovascular coiling.Of those who were treated with open surgery ,1 patient was chose the temporal polar approach, lpatient was chose the subtemporal approach . Of those who were treated with open surgery, 1 patient had angiospasm, 1 patient had a moderate disability, after activity management they both had a good recovery. Of those who were treated with parent artery occlusion, 1 patient had a postoperative visual field deficit,the others all had no serious complications.The outcome of 8 patients was good while one patients had the visual deficit. Conclusion The majority of the posterior cerebral artery aneurysms are located on the P2 segment.The most common clinical presentation of the posterior cerebral artery aneurysms is subarachoid hemorrhage.When we are dealing with these aneurysms,we often choose the endovascular treatment.When the endovascular treatment cannot be used,we can choose the open surgery.When dealing with some complicate aneurysms ,we can try to perform the bypass surgery.