基底动脉顶端动脉瘤的显微手术治疗策略  

Microsurgical strategy in the treatment of basilar apex aneurysms

作　　者：王红光[1] 佟小光[1] 王世波[1] 王计伟[1] 李旭东[1] 贾强[1] 梁伟伦[1] 程磊 范一木[1] Wang Hongguang;Tong Xiaoguang;Wang Shibo;Wang Jiwei;Li Xudong;Jia Qiang;Liang Weilun;Cheng Lei;Fan Yimu(Department of Neurosurgery,Tianjin Huanhu Hospital,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases,Tianjin 300350,China)

机构地区：[1]天津市环湖医院神经外科,天津市脑血管病与神经变性重点实验室,300350

出　　处：《中华神经外科杂志》2021年第3期250-254,共5页Chinese Journal of Neurosurgery

基　　金：天津市科技重大专项与工程(18ZXDBSY00180);天津市自然科学基金(20JCYBJC00940)。

摘　　要：目的探讨基底动脉顶端动脉瘤的显微外科手术治疗策略。方法回顾性分析2010年1月至2020年1月天津市环湖医院神经外科采用显微手术治疗的55例(共64个动脉瘤)基底动脉顶端动脉瘤患者的临床资料。根据动脉瘤的大小、指向以及瘤颈与后床突的位置关系选择手术入路,分别采用经翼点入路(25例)、经眶颧入路(5例)、经颞下入路(19例)及颞前-经颧-经海绵窦入路(6例)夹闭动脉瘤。采用改良Rankin量表评分(mRS)评估预后;采用CT血管成像(CTA)评估手术夹闭效果。结果55例患者中,动脉瘤完全夹闭46例(83.6%),部分夹闭9例;手术时长为(4.4±1.1)h(2.8~7.1 h)。11例患者术后出现脑缺血症状,其中1例死亡;21例患者出现动眼神经麻痹,其中4例因脑积水行脑室-腹腔分流术。共42例患者获得随访,随访时间为0.8~9.7年(中位时间为4.7年)。42例患者术后6个月随访时的mRS 0分32例,1分4例,2分2例,3分2例,4分1例,6分1例(随访期间因肺栓塞死亡)。CTA随访结果显示,完全夹闭的动脉瘤未见复发,载瘤动脉血流通畅;部分夹闭的动脉瘤均未见瘤体明显增大。结论开颅夹闭手术仍是基底动脉顶端动脉瘤的主要治疗方式。选择个体化的手术入路处理基底动脉顶端动脉瘤,能够获得良好的治疗效果。Objective To discuss the method and strategy of microsurgical treatment for basilar apex aneurysms(BAA).Methods A retrospective study was conducted on the clinical data of 55 patients with BAA who were treated with microsurgery at Department of Neurosurgery,Tianjin Huanhu Hospital from January 2010 to January 2020.Based on the size,direction,and relationship of the aneurysm neck to posterior clinoid process,different surgical approaches were employed and included pterional approach in 25 cases,orbito-zygomatic approach in 5 cases,subtemporal approach in 19 cases and pretemporal transzygomatic transcavernous approach in 6 cases.Modified Rankin Scale(mRS)was used to evaluate the outcomes during the follow-up period.Computerized tomography angiography(CTA)was performed to assess the effect of surgical clipping.Results Of all 55 patients,the aneurysm was completely clipped in 46(83.6%)and partially clipped in 9.The operation duration was 4.4±1.1 h(2.8-7.1 h).Eleven patients developed symptoms of ischemia after surgery,of which one died.Twenty-one patients developed oculomotor nerve palsy.Four patients underwent ventriculoperitoneal shunting due to hydrocephalus.A total of 42 patients underwent follow-up.The median follow-up duration was 4.7 years(0.8-9.7 years).Follow-up at 6 months post operation showed that the mRS score was 0 in 32 cases,1 in 4 cases,2 in 2 cases,3 in 2 cases,4 in 1 case,and 6 in 1 case.Imaging follow-up with CTA indicated that aneurysms clipped completely had no recurrence and all the associated arteries were unobstructed.No obvious enlargement of aneurysm was reported which had been partially clipped.Conclusions Microsurgical clipping remains to be a major therapeutic option for BAA.Patients with BAA could achieve satisfactory results via individualized selection of microsurgical approaches.

关 键 词：颅内动脉瘤 基底动脉 显微外科手术 手术入路 治疗结果 

分 类 号：R651.12[医药卫生—外科学]