颅内后循环动脉瘤的手术治疗(附35例分析)

目的探讨颅内后循环动脉瘤的临床特点和显微手术治疗策略及疗效。方法总结35例椎基底动脉系统动脉瘤的手术经验。共夹闭41个动脉瘤，动脉瘤孤立并切除2例，动脉瘤包裹1例。绝大部分病例术中采用了血管临时阻断技术，血管阻断的同时给予脑保护剂治疗，应用电生理监测。5例采用深低温停循环技术，在低温停循环条件下夹闭动脉瘤。结果28例术后行DSA检查，示动脉瘤夹闭满意27例。早期结果好（GOS4-5分）25例，差（GOS2-3分）7例，死亡3例。对31例随访3个月-8年，结果好27例，差2例．死亡2例。主要并发症有偏瘫、脑神经麻痹、脑脊液耳漏和颅内感染等。结论后循环动脉瘤中巨型和大型者较前循环动脉瘤更为常见。手术应从入路选择、术中脑保护、临时阻断载瘤动脉、合理处理动脉瘤、亚低温及深低温停循环的应用等方面综合考虑，以取得较满意效果。

Surgery for posterior circulation intracranial aneurysms: analysis of 35 cases

Objective To explore the clinical features, microsurgical treatment strategy and therapeutic effect of posterior circulation intracranial aneurysms. Methods Operation experiences of 35 cases with vertebrobasilar system aneurysms were retrospectively summarized. Forty-one aneurysms were directly clipped, 2 were isolated and resected, and 1 was wrapped. Techniques of brain protection, electrophysiological monitoring and temporary occlusion of the parent artery were used intraoperatively in most of the patients. Deep hypothermic circulatory arrest was conducted in 5 patients. Results Postoperative DSA was taken in 28 patients, showing that the aneurysms were clipped satisfactorily in 27 cases. At early postoperative stage, good outcome (GOS sore of 4 or 5) was achieved in 25 patients, poor (GOS score of 2 or 3) in 7, and death in 3. Thirty-one patients were followed up for 3 months to 8 years after surgery, and good outcome was achieved in 27 patients, poor in 2, and death in 2. The main complications were hemiplegia, cranial nerve palsy, cerebrospinal otorrhea and intracranial infection etc. Conclusion Large and huge aneurysms were more common in the posterior circulation than in the anterior circulation. Proper surgical approach, procedures of temporary occlusion of parent arteries, brain protection and hypothermic circulatory arrests should be synthetically considered to use based on the different situations during operation to achieve satisfactory outcome.