小脑后下动脉动脉瘤的显微手术治疗  

Microsurgery for posterior inferior cerebellar artery aneurysms(report of 31 cases)

作　　者：谭海斌[1] 黄光富[1] 徐荣华[2] 李志立[1] 王振宇[1] 

机构地区：[1]四川省人民医院神经外科,成都610072 [2]成都市第一人民医院神经外科,610072

出　　处：《中国临床神经外科杂志》2014年第8期467-469,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨小脑后下动脉动脉瘤显微手术的方法及其效果。方法回顾性分析我院从2008年1月至2013年8月显微手术夹闭的31例小脑后下动脉动脉瘤患者的临床资料,动脉瘤位于延髓前段9例、延髓侧段6例、扁桃体延髓段5例、终末扁桃体段7例、扁桃体上端区域4例;术前Hunt-Hess分级Ⅰ级10例,Ⅱ级14例,Ⅲ级7例;采用远外侧入路15例、乳突后枕骨下入路7例、枕骨后正中入路9例。结果术后6个月,运用改良Rankin量表(mRS)评分评估患者预后,mRS评分0分20例,1分5例,2分3例,4分1例(Hunt-Hess分级Ⅱ级),6分2例(1例死于肿瘤感染,1例死于)。结论小脑后下动脉动脉瘤破裂常表现脑干周围蛛网膜下腔出血,或仅表现为第四脑室出血;小脑后下动脉常有变异,CT血管造影不易发现动脉瘤;受小脑后下动脉动脉瘤的位置和解剖变异的影响,手术入路应给予个性化考虑。Objective To explore the anatomical variations of posterior inferior cerebellar artery （PICA） and the microsurgical method to treat saceular PICA aneurysms in the different regions. Methods The clinical data of 31 patients with saccular PICA aneurysms, who underwent microsurgery in our hospital from January, 2008 to August, 2013, were analyzed retrospectively, including clinical manifestations, imaging data, surgical treatment and following up data. Results Of 31 aneurysms, 9 were located in the medullary anterior segment, 6 in the medullary lateral segment, 5 in the tonsillar medullary segment, 7 in the terminal tonsillar segment and 4 in the upper tonsillae cerebelli. According to the Hunt-Hess scale, of 31 patients, 10 were in Hunt-Hess grade I , 14 in grade II, and 7 in grade Ill. The operative approaches included the far lateral approach （n=15）, the postmastoid suboccipital approach （n=7）, and the occiput posterior median approach （n=9）. The modified Rankin scale （mRS） was used to evaluate the clinical sffects. The following up 6 months after the operation showed that of 31 patients, 20 had no neurological deficit （mRS=0）, 5 had syndromes and no neurological dysfunction （mRS=l）, 3 slight neurological dysfunction （mRS=2）, 1 severe neurological dysfunction （mRS=4）, and 2 died （mRS=6）. Conclusions Subarachnoid hemorrhage around the brain stem, or even hemorrhage only in the fourth ventricle were often seen by CT in the patients with ruptured PICA aneurysms. PICA usually has multiple variations and PICA aneurysms are not found very effectively by CT angiography. Individual operative approach should be taken into account for each patient with PICA aneurysms because of the location of PICA aneurysms and anatomical variations.

关 键 词：颅内动脉瘤 小脑后下动脉 蛛网膜下腔出血 显微手术 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]