椎动脉V4段梭形动脉瘤的手术治疗

Surgical treatment of spindle aneurysms in V4 segment of vertebral artery

目的探讨椎动脉V4段梭形动脉瘤的手术治疗方法。方法回顾性分析2011年1日至2018年11月首都医科大学三博脑科医院收治的6例椎动脉V4段梭形动脉瘤患者的临床资料、手术方式及预后。结果6例患者中男4例,女2例,年龄45~65岁,动脉瘤破裂出血3例,所有患者均采用远外侧入路。1例选择窗型动脉瘤夹夹闭,2例选择枕动脉(OA)-小脑后下动脉(PICA)搭桥后再处理动脉瘤,3例选择单纯闭塞载瘤椎动脉。术后患者一般情况良好,术后CT血管造影证实2例搭桥术后搭桥血管通畅;所有椎动脉动脉瘤处理满意,PICA动脉保留。5例患者行气管切开(1例术前切开),术后3个月3例患者拔除气管切开套管,格拉斯哥预后量表(GOS)评分4分。1例长期气管切开,GOS评分3分。2例患者分别于术后4个月、3年死亡。结论开颅手术是治疗椎动脉V4段梭形动脉瘤的一种重要方法,应根据动脉瘤大小、与PICA的位置关系、椎动脉代偿情况选择不同的手术方式。

Objective To explore the surgical treatment of spindle aneurysms in V4 segment of vertebral artery. Methods The clinical data, surgical methods and prognosis of 6 patients with V4 spindle aneurysms of vertebral artery admitted from 2011 to November 2018 in Sanbo Brain Hospital were retrospectively analyzed. Results There were 4 males and 2 females aged from 45 to 65 years. Aneurysm rupture and bleeding occurred in 3 cases. Far lateral approach was used in all patients. One case was clipped with window aneurysms, 2 cases were treated with occipital artery (OA)-posterior inferior cerebellar artery (PICA) bypass, and 3 cases were treated with vertebral artery occlusion. Postoperative patients were generally in good condition. Postoperative CT arteriography confirmed that the bypass vessels were unobstructed in 2 cases. All vertebral aneurysms were treated satisfactorily and PICA arteries were preserved. Tracheotomy was performed in 5 patients (1 case was incised before operation). Three patients were removed 3 months after operation. The Glasgow Prognosis Score (GOS) was 4 points. Long-term tracheotomy was performed in 1 case, and GOS score was 3 points. Two patients died 4 months and 3 years after operation. Conclusions Craniotomy is an important method for the treatment of spindle aneurysm of V4 segment of vertebral artery. Different surgical methods should be selected according to the size of the aneurysm, the relationship between the location of the aneurysm and PICA, and the compensation of the vertebral artery.