椎动脉-小脑后下动脉复合体动脉瘤的临床特点和手术治疗

Clinical feature and surgical approaches for aneurysms of the vertebral artery-posterior inferior cerebellar artery complex

目的总结椎动脉-小脑后下动脉复合体(VA-PICAC)动脉瘤的临床特点,探讨其最佳手术入路。方法回顾性分析26例VA-PICAC动脉瘤病人的临床特点和手术疗效。首发症状为颅内出血者18例,脑神经障碍4例,头晕、头痛4例。动脉瘤位于椎动脉-小脑后下动脉(VA-PICA)13例,其中行枕下外侧入路10例,远外侧入路2例,远外侧经髁入路1例;小脑后下动脉(PICA)10例,其中行后正中开颅9例,枕下外侧入路1例;椎基底动脉结合部(VA-BA)动脉瘤3例,其中行枕下外侧入路2例,神经导航指导远外侧入路1例。结果术后出现并发症9例,其中意识障碍致死亡3例,其他并发症包括短期呼吸间歇或暂停、癫疒间、舌咽与迷走神经功能障碍、脑积水等。复查全脑血管DSA 14例,仅1例动脉瘤有残余。出院时疗效优18例,良3例,一般2例。随访17例,疗效优14例,良3例。结论根据VA-PICAC动脉瘤部位选择相应的手术入路,有助于减少并发症。

Objective To summarize the clinical features of the aneurysms of the vertebral artery-posterior inferior cerebella artery complex(VA-PICAC) and explore the optimal surgical approaches.Methods The clinical features and surgical results of 26 patients with VA-PICAC aneurysms were analyzed retrospectively.Eighteen patients were admitted for the initial symptom of intracranial hemorrhage,4 for cranial nerve dysfunction,and 6 for intracranial space-occupying lesions.In 13 patients with VA-PICA aneurysms,10 underwent surgery via a lateral suboccipital approach,2 via far lateral approach,and 1 via far lateral transcondylar approach.Of the 10 patients with posterior inferior cerebella artery(PICA) aneurysms,9 received surgery through a midline suboccipital approach,and 1 through a lateral suboccipital approach.Two of the 3 patients with basilar artery apex aneurysms were surgically managed via lateral suboccipital approach and 1 via far lateral approach with the assistance of neuronavigation.Results Nine patients developed postoperative complications causing death in 3 cases with conscious disturbance.The other complications included short-term respiratory arrest,epileptic seizures,Ⅸ or Ⅹ cranial nerve dysfunction,and hydrocephalus etc.Postoperative digital subtraction angiography(DSA) performed in 14 cases revealed successful management of aneurysms in 13 cases.Excellent surgical results were achieved in 18 cases upon discharge,good results in 3,and acceptable results in 2.Among the 17 patients followed up,the outcome scale was excellent in 14 and good in 3 cases.Conclusion Appropriate surgical approach selection according to the location and shape of the VA-PICAC aneurysms may reduce the postoperative complications.