显微夹闭术和血管内栓塞治疗颅内后循环动脉瘤的疗效比较

目的比较显微夹闭术和血管内栓塞治疗颅内后循环动脉瘤的疗效。方法回顾性分析2009年1月至2019年1月收治的40例颅内后循环动脉瘤的临床资料。显微夹闭术治疗20例(夹闭组),血管内栓塞治疗20例(栓塞组)。结果术后6个月,预后良好33例(GOS评分4~5分),预后差6例(GOS评分2~3分),死亡1例。夹闭组预后良好17例,术后发生脑缺血3例、颅神经麻痹5例,动脉瘤瘤颈残留1例。栓塞组预后良好16例,术后发生脑缺血2例、颅神经麻痹1例,动脉瘤瘤颈残留9例。夹闭组动脉瘤瘤颈残留发生率(5.0%,1/20)明显低于栓塞组(45.0%,9/20;P<0.05),而两组预后良好率、术后脑缺血发生率、颅神经麻痹发生率均无统计学差异(P>0.05)。结论颅内后循环动脉瘤需要显微夹闭术与血管内栓塞治疗协同,权衡每种治疗方式的优缺点,以获得期望的疗效。

Comparison of curative effect between microsurgical clipping and endovascular embolization for intracranial posterior circulation aneurysms

Objective To compare the curative effect between microsurgical clipping and endovascular embolization for intracranial posterior circulation aneurysms. Methods The clinical data of 40 patients with intracranial posterior circulation aneurysms, of whom 20 patients underwent microsurgical clipping (clipping group) and 20 patients received endovascular ombolization (ombolization group), from January 2009 to January 2019 were retrospectively analyzed. Results Six months after the operation, 33 patients had a good prognosis (GOS score of 4~5), 6 patients had a poor prognosis (GOS score of 2~3), and 1 died. There was no significant difference in the rate of good prognosis, and incidence of ischemic complications and cranial nerve paralysis between both groups (P>0.05). The rate of remnants of clipping group (5.0%, 1/20) was significantly lower than that (45.0%, 9/20) of embolization group (P<0.05). Conclusions Intracranial posterior circulation aneurysms present a unique therapeutic challenge that requires concerted efforts by microsurgery and endovascular treatment, weighing the pros and cons of each treatment in order to achieve the desired outcome