颅内后循环远端动脉瘤的外科治疗  

Surgical management of intracranial aneurysms of the distal posterior circulation

作　　者：韩超[1] 王成伟[1] 丁璇[1] 孟庆虎[1] 

机构地区：[1]山东大学第二医院神经外科,山东济南250033

出　　处：《山东大学学报（医学版）》2016年第10期66-70,共5页Journal of Shandong University:Health Sciences

基　　金：山东大学第二医院青年基金(Y2014010031)

摘　　要：目的探讨颅内后循环远端动脉瘤外科治疗的效果及安全性。方法回顾性分析收治的16例破裂后循环远端动脉瘤病例共18枚动脉瘤的临床资料,其中脉络膜后动脉远端1例,大脑后动脉远端2例,小脑上动脉远端3例,小脑前下动脉远端4例,小脑后下动脉远端6例(8枚动脉瘤)。结果 4例使用微弹簧圈栓塞动脉瘤的患者均保持了载瘤动脉通畅,7例采用微弹簧圈+Onyx胶或仅用Onyx胶进行载瘤动脉闭塞,5例共7枚动脉瘤行开颅手术夹闭。其中3例术后出现无症状性小脑梗死,11例进行了DSA或CTA随访,均未见动脉瘤复发。结论后循环解剖变异较大,且侧支循环通常较好,动脉闭塞引起脑干缺血的风险较低。位于脑干前方及外侧的囊状动脉瘤,治疗时争取保留载瘤动脉通畅。如果动脉瘤远离脑干,可以直接闭塞载瘤动脉,且通常不会发生致命的缺血,安全有效。Objective To explore the efficacy and safety of surgical management in intracranial aneurysms of the distal posterior circulation. Methods Clinical data of 16 patients with intracranial aneurysms of the distal posterior circulation who underwent surgical or interventional management were retrospectively reviewed. The locations of the aneurysms included： 1 posterior choroidal artery（ PCh A）,2 posterior cerebral arteries（ PCA）,3 superior cerebellar arteries（ SCA）,4 anterior inferior cerebellar arteries（ AICA）,and 8 posterior inferior cerebellar arteries（ PICA） in 6patients. Results The parent arteries of 4 patients who received micro-coil embolization remained patent; the parent arteries of 7 patients who received Onyx with or without micro-coil were obstructed; the 7 aneurysms in 5 cases were clipped. Asymptomatic cerebellar infarction occurred in 3 cases. DSA or CTA follow-up in 11 cases showed no recurrence. Conclusion Due to the sufficient collateral circulation and anatomic variation,brain stem infarction resulted from occlusion is rarely seen. Saccular aneurysm in the front or outside of brain stem should be managed with parent artery preservation. Occlusion of the parent artery of aneurysms of the distal posterior circulation is safe and efficient.

关 键 词：后循环 颅内动脉瘤 载瘤动脉闭塞术 

分 类 号：R651[医药卫生—外科学]