颅内后循环动脉瘤

目的:回顾性分析并探讨颅内后循环动脉瘤的临床表现和手术人路。方法:后循环动脉瘤22例,占同期颅内动脉瘤的10.3％,其中大脑后动脉瘤12例,基底动脉瘤6例,脉络膜后动脉远端动脉瘤2例,小脑前下动脉和小脑后下动脉瘤各1例。蛛网膜下腔出血15例(68.2％),其它表现为脑干和脑神经损害症状。18例经显微手术,主要经翼点人路和颞下经小脑幕人路。2例栓塞治疗,2例因病人拒绝未治。结果:动脉瘤夹闭加切除10例,孤立加切除6例,包裹2例,血管内治疗2例。18例优良,2例轻残,无手术死亡。结论:后循环动脉瘤大多瘤体较大,瘤内多含血栓。翼点人路对基底动脉远端、大脑后动脉P_(1 2)段动脉瘤显露优良,颞下入路用于夹闭大脑后动脉P_(2～3)段动脉瘤,显露优良。

Intracranial aneurysms of the posterior cerebral circulation

In order to analyse and explore the clinical manifestation and surgical approach of in-tracramal aneurysms of posterior circulation. Method: 22 patients with vertebrobasilar a-neurysms were treated in Xanjing General Hospital of PLA from 1979 to 1996,it accounts for 10.3% of all intracranial aneurysms, including the aneurysms of posterior cerebral artery in 12 cases, basilar artery in 6 cases, posterior choroidal artery in 2 cases, anterior inferior cerebellar artery and posterior inferior cerebellar artery in 1 case respectively. The subarachnoid hemorrhage was manifested in 15 cases (68. 2%). The other clinical manifestations were dysfunction of the brain stem and cranial nerve. The microsurgical technique were used via pterional approach or subtemporal approach in 18 cases. The aneurys-mal embolization were performed in 2 cases. Another 2 patients refused to be treated. Result: The aneurysms were clipped and resected in 10 cases, trapped and resected in 6 cases, and wrapped in 2 cases. The excellent curative effect was gained in 18 cases, 2 patients suffered from mild morbidity. There was no operative mortality. Conclusion: The most of aneurysms of posterior circulation were large in size, and always with thrombus in the aneurysmal sac. A good exposure field could be gained by pterional approach for the distal basilar artery and the P_(1~2) segment of posterior cerebral aneurysms. The subtemporal approach was suited for clipping the P_(2~3) segment of posterior cerebral aneurysms.