颅内远端动脉瘤的外科治疗

Surgical managements of peripheral intracranial aneurysms

目的 探讨颅内远端动脉瘤的临床特点和治疗策略.方法 回顾分析解放军总医院2008年10月至2011年10月治疗的24例颅内远端动脉瘤,男13例,女11例,年龄38～68岁,平均46岁.其中大脑前动脉远端动脉瘤12例,大脑中动脉远端动脉瘤3例,大脑后动脉远端动脉瘤2例,小脑上动脉远端动脉瘤1例,小脑前下动脉远端动脉瘤例2例,小脑后下动脉远端动脉瘤2例,脉络膜后内侧动脉瘤2例.8例远端动脉瘤在神经导航下进行,2例在术中磁共振导航辅助下进行.16例行动脉瘤单纯夹闭;4例行动脉瘤夹闭载瘤动脉重建;2例行动脉瘤切除术;1例行动脉瘤切除远近端吻合术;1例行动脉瘤孤立颅内外血管架桥术.结果 出院时格拉斯哥评分（GOS）5分者20例,4分者（轻残）4例.2例术后出现动眼神经麻痹,随访3个月2例均恢复.1例术后出现部分视野缺损.结论 颅内远端动脉瘤较为少见,术中精确定位是处理远端动脉瘤的关键,根据动脉瘤的不同特点应采取不同的治疗策略.

Objective To explore the clinical characteristics and treatment strategies of peripheral intracranial aneurysms.Methods A total of 24 patients of peripheral aneurysms from October 2008 to October 2011 were retrospectively analyzed.There were 11 females and 13 males with a mean age of 46 （38-38） years.Of the 24 patients, 11 were female and 13 were male, mean age was 46 years （ranged 38-68）.The distributions of the lesions included 12 peripheral anterior cerebral artery （n=12）, aneurysms, 3 peripheral middle cerebral artery （n=3） aneurysms, 2 peripheral posterior cerebral artery （n=2） aneurysms, 1 peripheral superior cerebellar artery （n=1） aneurysm, 2 anterior inferior cerebellar artery （n=2） aneurysms, 2 posterior inferior cerebellar artery （n=2） aneurysms, and 2 medial posterior choroidal artery （n=2） aneurysm.Eight procedures were performed by under neuro-navigation, and another 2 under were performed by intraoperative magnetic resonance imaging （MRI） and navigation.The procedures included Sixteen peripheral aneurysms were simple y clipping （n=16）ed, 4 were clipping plus reconstruction of ed and parent arteries （n=4） reconstructed, resection （n=2） and resection plus reanastomosis 2 were resected, 1 was resected andof parent artery （n=1） and EC-IC bypass （n=1） was reanastomosed, and 1 was trapped with EC-IC bypass.Results At discharge, 20 of them out of the 24 patients had a Glasgow Outcome Scale （GOS） score of 5, and another 4 patients had yielded a score of 4.Two oculomotor nerve palsies occurred postoperatively and , with bboth improved in during a 3-month follow-ing up period.One patient case had postoperative partial visual field defect.Conclusions The pPeripheral intracranial aneurysms are a rare in clinical practices.kind of entity.Precise intraoperative localization of the lesions is the of key importance for managementto the procedure.Different treatment strategies should be taken based on their diverse different characteristics of the aneurysm.