大脑后动脉动脉瘤的显微手术治疗

目的探讨大脑后动脉(PCA)动脉瘤的临床特征、显微外科治疗的方法及效果。方法 2002年1月至2011年6月显微手术治疗PCA动脉瘤14例,其中经翼点入路手术2例,颞下入路手术11例,Poppen入路手术1例。10例动脉瘤行动脉瘤瘤颈夹闭术,1例梭形动脉瘤行动脉瘤孤立术,3例闭塞载瘤动脉。结果术后1周死亡1例,植物生存1例,偏瘫及动眼神经麻痹4例,无明显并发症8例;术后1周至6月,6例行DSA复查,5例行CT血管造影复查,其中7例动脉瘤完全夹闭,2例瘤颈仍残留;1例动脉瘤夹位置移位。12例病人成功随访2~9年,7例恢复良好,3例肢体偏瘫,1例动眼神经仍麻痹,1例术后昏迷卧床3年发生肺部感染后死亡。结论 PCA动脉瘤发病率较低,手术入路的选择与动脉瘤的位置密切相关,术中应尽可能保护脑干、大脑后动脉的穿支及动眼神经等颅内重要解剖结构。

Microsurgery for posterior cerebral artery aneurysms (report of 14 cases)

ObjectiveTo investigate the clinical characteristics and microsurgical technique of the posterior cerebral artery(PCA) aneurysms and the curative effects of microsurgery on PCA aneurysms.Methods The clinical and following up data of 14 patients with PCA aneurysms,who underwent microsurgery from January,2002,to June,2011,were analyzed retrospectively.Of 14 patients with PCA aneurysms,10 underwent clipping the necks of the aneurysms,1 trapping of aneurysm,and 3 clipping the parent arteries.Results Of 14 patients,8 were recovered well,4 had semiplegia and oculomotor nerve palsy,1 survived vegetatively and 1 died.Of 12 patients were followed up from 2 to 9 years,7 were recovered well,3 had semiplegia,1 still had oculomotor nerve palsy and 1 died of pulmonary infection 3 years after the surgery.Conclusions The choice of surgical approach is closely related to the location of PCA aneurysms.The brain stem,PCA perforating artery,oculomotor nerve and other important anatomical structures should be intraoperatively protected as well as possible in the patients with PCA aneurysms.