颅内后循环动脉瘤的显微手术治疗

目的总结分析颅内后循环动脉瘤的临床特征、手术入路及手术技巧。方法回顾性分析我院19例经显微手术治疗的后循环动脉瘤患者的临床资料。此19例中,6例手术经颞下入路,7例经翼点或扩大翼点入路,3例经枕下乙状窦后入路,2例经枕下旁正中入路,1例经扩大颞瓣入路。结果9例患者动脉瘤成功夹闭,5例患者动脉瘤成功夹闭后行瘤体切除,5例患者动脉瘤被成功包裹。术后5例出现一过性动眼神经麻痹,3例出现同向偏盲,3例出现偏瘫,1例死亡。3例患者术后因脑积水同时行脑室-腹腔分流术。随访3月～6年,3例行瘤颈夹闭者见动脉瘤消失,载瘤动脉通畅,1例包裹者动脉瘤瘤体增大,1例患者在术后2年因动脉瘤突发破裂导致死亡。结论对于后循环动脉瘤患者需选择合适的手术入路,充分地显露动脉瘤和载瘤动脉。术中注意对神经及穿支血管的保护,可明显减少术后并发症。

Microsurgery for Intracranial Aneurysms of Posterior Circulation

Objectives To summarize the clinical features of intracranial aneurysms of posterior circulation,and the surgical approaches and operative skills to treat them. Methods The clinical data of 19 patients with posterior circulation aneurysms,of whom,6 patients underwent surgery through subtemporal approach,7 through transpterional or improved transpterional approach,3 through suboccipital posterior sigmoid approach,2 through lateral suboccipital approach and 1 through large temporal flap approach,were analysed retrospectively. Results The aneurysms were successfully clipped in 9 patients,the aneurysmal bodies were successfully resected after clipping aneurysmal necks in 5 and the aneurysms were successfully wrapped in 5. The temporal oculomotor palsy occurred in 5 patients,syntropic hemiablepsia occurred in 3 and light hemiplegia in 3,and 1 patient died after the operation. The ventriculoperitonreal shunt was performed in 3 patients because of postopetative hydrocephalus. The following up from 3 months to 6 years showed that the body of aneurysm wrapped became large in 1 patients and 1 patient died of the aneurysmal rupture 2 years after the operation. Conclusions A proper surgical approach should be selected for good exposure of aneurysm and its parent artery. Protection of the nerves and the perforating branches of the relative arteries during the operation can reduce the postoperative complications.