大脑后动脉第2段动脉瘤

Posterior cerebral artery aneurysm on P_2 segment

目的 对本院 1990年以来治疗的 11例大脑后动脉第 2段 (P2 段 )动脉瘤的临床和手术处理进行回顾性分析。方法 11例患者中 ,10例行手术治疗 ,其中 6例经颞下入路、4例经翼点入路。5例行动脉瘤瘤颈夹闭或塑形夹闭并保留载瘤动脉通畅 ,5例巨大动脉瘤行动脉瘤孤立切除术 ;另l例行血管内弹簧栓栓塞术。结果 手术治疗的 10例患者 8例术后恢复良好 ;其中包括 5例动脉瘤夹闭者以及 3例动脉瘤孤立者 ,另外 2例动脉瘤孤立术后发生大脑后动脉供血区脑组织缺血性梗死 ,出现暂时性轻偏瘫和同向性偏盲。l例动脉瘤血管内栓塞术后动脉瘤消失 ,载瘤动脉通畅 ,恢复良好。结论 P2 段动脉瘤多见于年轻人 ,有形成巨大动脉瘤的倾向。手术以经翼点入路和颞下入路显露为主 。

Objective The P 2 segment of the posterior cerebral artery(PCA) has been a challenging region to be exposed surgically. The clinical and surgical treatment of the aneurysms on the P 2 segment of the posterior cerebral artery was retrospectively reviewed in 11 patients.Methods Ten of 11 P 2 segment aneurysms were surgically treated with 6 cases via subtemporal and 4 via pterional approach. Five aneurysms were successfully treated by clipping the aneurysmal neck with parent artery patent, five giant aneurysms were treated by trapping, and the other one was treated with intraaneurysm coils.Results Eight of 10 operated patients had postoperative good recovery, 5 patients with clipping of aneurismal neck and 3 patients with aneurysm trapping. Ischemic infarct in the PCA territory occurred in 2 patients with aneurysm trapping. The other one with endovascular coils had a good result.Conclusion The aneurysms on the P 2 segment of the posterior cerebral artery had a tendency to become large or giant. The exposure of these aneurysms could be gained via pterional approach for the aneurysms on the anterior P 2 segment and via subtemporal approach for the aneurysms on the posterior P 2 segment.