颅内后循环动脉瘤的临床特征及显微外科手术策略  

Clinical characteristics and microsurgical strategy of intracranial posterior circulation aneurysms

作　　者：张鹏[1] 孙红卫[1] 王蒙蒙[1] 李天豪[1] 丁大领[1] 刘献志[1] Zhang Peng;Sun Hongwei;Wang Mengmeng;Li Tianhao;Ding Daling;Liu Xianzhi(Department of Neurosurgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China)

机构地区：[1]郑州大学第一附属医院神经外科,郑州450052

出　　处：《中华医学杂志》2019年第20期1558-1561,共4页National Medical Journal of China

基　　金：国家留学基金委出国研修计划项目(201707045032).

摘　　要：目的探讨颅内后循环动脉瘤的临床特征及显微外科手术策略。方法回顾郑州大学第一附属医院2013年1月至2018年1月显微外科手术治疗后循环动脉瘤35例(动脉瘤37枚)患者的临床表现、影像学资料、手术入路和随访结果。结果共夹闭动脉瘤22个,夹闭并切除动脉瘤13例,1例行动脉瘤夹闭并动静脉畸形切除术,1例行孤立术;其中基底动脉顶端动脉瘤11例,大脑后动脉瘤10例,小脑后下动脉瘤6例,基底动脉瘤3例,椎动脉瘤3例(其中夹层动脉瘤1例),小脑上动脉瘤及小脑前下动脉瘤各2例;手术入路包括翼点入路、扩大翼点入路、颞下入路、乙状窦后入路和远外侧入路。出院6个月按GOS评分,24例恢复良好,6例轻度神经功能障碍,2例重度神经功能障碍,1例植物生存状态,2例死亡。结论后循环动脉瘤毗邻重要结构,位置深,操作空间小,手术难度大;术前充分评估,选择合适手术方式是患者获益的关键。Objective To explore the clinical characteristics and microsurgical strategies of intracranial posterior circulation aneurysms. Methods The clinical manifestations, imaging data, surgical approaches and follow-up results of 35 patients with circulating aneurysms (37 aneurysms) treated by microsurgery in the First Affiliated Hospital of Zhengzhou University from January 2013 to January 2018 were analyzed retrospectively. Results A total of 22 aneurysms were clipped, 13 were clipped and resected, 1 case was clipped and together with AVM resection and 1 case was isolated. Of 37 aneurysms in 35 patients, 11 aneurysms were at the basilar artery apexes, 10 at the posterior cerebral arteries, 6 at the posterior inferior cerebellar arteries, 3 at the basilar arteries, 3 at the vertebral arteries (including 1 case of vertebral arterial dissecting aneurysm), 2 at the anterior inferior cerebellar arteries and 2 at the superior cerebellar arteries. The surgical approaches included pterional approach, extensive pterional approach, infratemporal fossa approach, retrosigmoid approach and far-lateral approach. The Glasgow Outcome Scale (GOS) scores showed good recovery in 24 cases, moderate neurological dysfunction in 6 cases, severe neurological dysfunction in 2 cases, persistent vegetative state in 1 case and 2 cases of death 6 months after their discharge from hospital. Conclusions Posterior circulation aneurysms are adjacent to important structures. They are deep in position, with small operation space and difficult to operate. Full preoperative evaluation of the condition, selection of appropriate surgical methods are the key factors to benefit the patients.

关 键 词：颅内动脉瘤 疾病特征 显微外科手术 后循环 

分 类 号：R651.12[医药卫生—外科学]