大脑后动脉P1、P2段动脉瘤的手术治疗  

Microsurgical treatment of aneurysm in the posterior cerebral artery on P1 and P2 segments

作　　者：顾建军[1,2] 张世明[1] 王中[1] 周幽心[1] 虞正权[1] 李向东[1] 崔岗[1] 周岱[1] 

机构地区：[1]苏州大学附属第一医院神经外科,江苏省215006 [2]泰州市人民医院神经外科

出　　处：《江苏医药》2013年第16期1909-1911,共3页Jiangsu Medical Journal

基　　金：江苏省医学重点学科基金资助项目(XR2007227)

摘　　要：目的探讨大脑后动脉P1、P2段动脉瘤显微手术治疗效果。方法回顾性分析10例大脑后动脉P1、P2段动脉瘤手术治疗资料。本组8例为破裂动脉瘤,头颅CT表现为蛛网膜下腔出血,出血可在脑干旁、鞍上池或颞叶内侧血肿块。2例为未破裂动脉瘤,表现为环池内占位性病变。入院时患者Hunt-Hess分级:Ⅰ-Ⅱ级3例,Ⅲ级6例,Ⅳ级1例。脑血管造影提示大脑后动脉P1、P2段动脉瘤,P1段和P1、P2交界处动脉瘤采用翼点入路,P2段动脉瘤采用颞下入路。结果 8例行动脉瘤颈夹闭术,2例行血管塑形动脉瘤夹闭术,术后CT血管造影显示动脉瘤消失,无脑缺血表现。3例有动眼神经麻痹,1例短暂同向偏盲,6个月后完全恢复。随访6个月-3年,恢复良好9例,植物生存1例。结论大脑后动脉动脉瘤手术难度大,选择正确的入路、掌握后循环的显微解剖和显微手术技巧是手术成功的关键。Objective To explore the outcomes of microsurgery for the aneurysm of the posterior cerebral artery（PCA） on P1 and P2 segments. Methods Ten cases of aneurysm of the PCA on P1 and P2 segments underwent microsurgery were analysed retrospectively. Eight cases had ruptured aneurysm with subarachnoid hemorrhage （SAH）, and/or hemorrhage beside the brainstem confirmed by CT. Two cases presented with occupying mass in the infrotentoria fossa. According to Hunt-Hess grade, 3 cases were in grade Ⅰ -Ⅱ conditions, 6 cases in grade Ⅲ, and 1 case in grade IV. All cases were diagnosed by DSA. Aneurysms on P1 segment and P1 and P2 juncture were surgically treated via transpterional approach and those on P2 segment were operated via subtemporal approach. Results Eight cases were completely treated by clipping the aneurismal ncek and 2 aneurysms were shaped. The aneurysms disappeared on the postoperative CTA image, and no ischemic infarction was seen. Three cases showed oculomotor palsy and 1 case showed transient homonymous hemianopsia. The patients were followed-up for 6 months to 3 years, which showed that 9 cases recovered well, 1 case was in vegetative state. Conclusion The microsurgery for intracranial aneurysms of the PCA on P1 and P2 segments is very difficult. The key for successful operation is to expose the aneurysms fully by appropriate approach and to master microdissection of posterior circulation and microsurgical techniques.

关 键 词：大脑后动脉 动脉瘤 显微手术 

分 类 号：R651[医药卫生—外科学]