关键词：动脉瘤；椎基底动脉；蛛网膜下腔出血；显微手术
摘要 目的：回顾性分析并探讨颅内后循环动脉瘤的临床表现和手术入路。方法：后循环动脉瘤22例，占同期颅内动脉瘤的10.3%，其中大脑后动脉瘤12例，基底动脉瘤6例，脉络膜后动脉远端动脉瘤2例，小脑前下动脉和小脑后下动脉瘤各1例。18例经显微手术，主要经翼点入路和颞下经小脑幕入路。结果：动脉瘤夹闭加切除10例，孤立加切除6例，包裹2例，血管内治疗2例，2例未治。18例优良，2例轻残，无手术死亡。结论：后循环动脉瘤大多瘤体较大，瘤内多含血栓。翼点入路对基底动脉远端、大脑后动脉P1-2段动脉瘤显露优良，颞下入路用于夹闭大脑后动脉P2-3段动脉瘤，显露优良。
Intracranial aneurysms of posterior circulation Zhang Yong, Shi Jixin, Liu Chengji, et al. Department of Neurosurgery, Jinling Hospital, Nanjing 210002
Abstract Objective: To evaluate the clinical features and surgical approaches of the intracranial aneurysms of posterior circulation retrospectively. Methods: 22 vertebrobasilar aneurysms were treated in our department through 1979 and 1996. Two surgical approaches including the pterional and the subtemporal approach were adopted. Of all intracranial aneurysms, vertebrobasilar artery aneurysms accounted for 10.3% (22/214), of which posterior cerebral artery 12 cases, basilar artery 6 cases, posterior choroidal artery 2 cases, anterior inferior cerebellar artery 1 case and posterior inferior cerebellar artery 1 case. There was subarachnoid hemorrhage(SAH) in 15 cases(68.2%). It was operated on by microsurgery in 18 cases. Aneurysm embolization was carried out in 2 cases and no treatment in the remaining 2 cases. Results: The outcome of 18 cases were excellent or good, 2 midly disable, and there was no mortality. Conclusions: The vertebrobasilar aneurysms tended to be large in size, to thrombose and present with compression symptoms of the brain stem and cranial nerves. The pterional approach could be available to expose the distal basilar-PCA-superior cerebellar artery and P1-P2 segment aneurysms, and the subtemporal approach for P2-P3 aneurysms. The aneurysms located in retroclival region are still most difficult to approach surgically.
Key words Intracranial aneurysms Vertebrobasilar artery Subarachnoid haemorrhage Microsurgery
我们于1979年10月至1996年12月收治22例后循环动脉瘤 ......
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