脑Willis动脉环远侧动脉瘤的诊断和治疗

Diagnosis and treatment of intracranial aneurysms far from the circle of Willis

目的 本文探讨脑Willis动脉环远侧动脉瘤的临床特点和治疗对策。方法 回顾性分析我科自1985年10月至2001年9月期间收治脑动脉远端的动脉瘤26例,其中位于大脑前动脉远侧段6例,大脑中动脉远侧段3例,大脑后动脉远侧段9例,小脑上动脉主干2例、小脑前下动脉主干1例,小脑后下动脉主干5例。动脉瘤最大径小于0.5 cm 9个,非囊状动脉瘤6例,合并脑AVM 5例。25例行手术治疗,1例合并脑干 AVM者采用γ-刀治疗AVM。结果 出院时临床状况优良者22例(84.6％),轻残者2例,重残者1例,死亡1例。另1例γ-刀治疗者在6个月后因动脉瘤再破裂出血而死亡。结论 脑Willis动脉环远侧动脉瘤的临床特点:①大脑后动脉(PCA)和小脑后下动脉(PICA)的远侧动脉瘤发生率高;②非囊状动脉瘤较多;③动脉瘤较小;④合并脑AVM的发生率高;⑤引起脑内血肿多。手术治疗效果良好,但合并脑AVM时手术效果较差。

Objective To probe into clinical features and therapy strategy of aneurysms far from the circle of Willis which are a special subgroup of intracranial aneurysms. Methods A retrospective analysis had been made of 26 patients with aneurysm far from the circle of Willis from October 1985 to September 2001, which was situated in ACA in 6 cases, MCA in 3 cases, PCA in 9cases, SCA in 2 cases, AICA in lease and PICA in Scases. There are 9 cases of small aneurysm less than 5mm, 6 cases of non-berry aneurysm and 5 cases associated with brain AVM. The operation was made in 25 patients and γ-knife was used in one patient with brain stem AVM. Results In operative group, outcome was considered as good in 22 cases (84.6% ), fair in 2 cases, poor in 1 cases and dead in 1 cases. Another patient with AICAA and Brain stem AVM treated by γ-knife, died 6 monthes post-treatment because of bleeding from the rupture of aneurysm. Conclusions Clinical features of the aneurysm far from the circle of Willis include ①high frequency in PCA and PICA,②less seen the non- berry aneurysm,③ size of aneurysm be small, ④associated with brain AVM,⑤rupture often causing intracerebral hematoma。 Active operative treatment is the best therapy strategy because the operative result is good, but one associated with brain AVM makes the operative result less better.