颅内后循环动脉瘤的手术治疗(附17例报告)

目的 报告颅内后循环动脉瘤的手术治疗和临床效果。方法 对17例颅内后循环动脉瘤施行显微外科手术。术中应用脑保护剂和血管临时阻断技术，1例采用低温停循环。结果 本组动脉瘤位于基底动脉分叉部及其分支12例，椎基底动脉结合部2例，小脑后下动脉3例。17例中，巨型动脉瘤7例，梭状或半梭状动脉瘤9例。10例行动脉瘤夹闭，5例行孤立，1例行包裹，1例行载瘤动脉近端阻断。手术后早期结果好11例，差5例，死亡例。经术后3个月至8年随访结果好14例，差1例，死亡1例。结论 后循环动脉瘤需要选择合适的手术入路，充分地显露动脉瘤和载瘤动脉，术中合理应用血管临时阻断和脑保护技术以及低温停循环。对于窄颈的中小型动脉瘤可以选择血管内栓塞，但对宽颈或不规则型巨大动脉瘤应采用积极的手术治疗。

Surgical treatment of intracranial posterior circulation aneurysms

Objective To report surgical treatment and clinical outcome of intracranial posterior circulation aneurysms.Methods Direct microsurgical repair of intracranial posterior circulation aneurysms was performed in 17 patients. Techniques of brain protection and temporary occlusion on parent arteris were used intraoperatively. Hypothermic circulatory arrest procedures were conducted in 1 patient. Clinical outcome was evaluated with Glasgow outcome scale (GOS) scores. Results The aneurysms located at basilar apex and its branches in 12 patients, at vertebrobasilar junction in 2 patients and at posteroinferior casebellar artery in 3 patients. The aneurysms were giant in 7 patients and semifusiform or fusiform in 9 patients. The aneurysms were clipped in 10 patients, trapped in 5 patient, and wrapped in 1 patient. Proximal parent artery of aneurysm was occluded in 1 patient. At postoperative early stage, good outcomes (GOS scores of 4 or 5) were achieved in 11 patients, poor outcomes (GOS scores of 2 or 3) in 5 patients, and death in 1 patient. Through 3 months to 8 years following up after surgery, good outcomes were achieved in 14 patient, poor outcome in 1 patient, and death in 1 patient. Conclusions Surgery of posterior circulation aneurysms is more difficult to be treated than anterior circulation aneurysms. A proper surgical approach should be taken to expose aneurysm and its parent artery clearly. Procedures of temporary occlusion of parent arteries and brain protection as well as hypothemic circulatory arrest could be used based on the different situation during operation. Endovascular embolization was indicated for aneurysms in regular size with narrow neck. However aggressive direct surgical repair should be taken for giant aneurysms or irregular aneurysms with wide neck.