颅内后循环远端动脉瘤的外科治疗

doi:10.6040/j.issn.1671-7554.0.2015.1316

山东大学学报（医学版） ›› 2016, Vol. 54 ›› Issue (10): 66-70.doi: 10.6040/j.issn.1671-7554.0.2015.1316

颅内后循环远端动脉瘤的外科治疗

韩超,王成伟,丁璇,孟庆虎

山东大学第二医院神经外科, 山东济南 250033

收稿日期:2015-12-22 出版日期:2016-10-10 发布日期:2016-10-10
通讯作者: 王成伟. E-mail:w6675778@126.com E-mail:w6675778@126.com
基金资助:
山东大学第二医院青年基金(Y2014010031)

Surgical management of intracranial aneurysms of the distal posterior circulation

HAN Chao, WANG Chengwei, DING Xuan, MENG Qinghu

Department of Neurosurgery, Second Hospital of Shandong University, Jinan 250033, Shandong, China

Received:2015-12-22 Online:2016-10-10 Published:2016-10-10

摘要/Abstract

摘要： 目的探讨颅内后循环远端动脉瘤外科治疗的效果及安全性。方法回顾性分析收治的16例破裂后循环远端动脉瘤病例共18枚动脉瘤的临床资料,其中脉络膜后动脉远端1例,大脑后动脉远端2例,小脑上动脉远端3例,小脑前下动脉远端4例,小脑后下动脉远端6例(8枚动脉瘤)。结果 4例使用微弹簧圈栓塞动脉瘤的患者均保持了载瘤动脉通畅,7例采用微弹簧圈+Onyx胶或仅用Onyx胶进行载瘤动脉闭塞,5例共7枚动脉瘤行开颅手术夹闭。其中3例术后出现无症状性小脑梗死,11例进行了DSA或CTA随访,均未见动脉瘤复发。结论后循环解剖变异较大,且侧支循环通常较好,动脉闭塞引起脑干缺血的风险较低。位于脑干前方及外侧的囊状动脉瘤,治疗时争取保留载瘤动脉通畅。如果动脉瘤远离脑干,可以直接闭塞载瘤动脉,且通常不会发生致命的缺血,安全有效。

关键词: 颅内动脉瘤, 载瘤动脉闭塞术, 后循环

Abstract: Objective To explore the efficacy and safety of surgical management in intracranial aneurysms of the distal posterior circulation. Methods Clinical data of 16 patients with intracranial aneurysms of the distal posterior circulation who underwent surgical or interventional management were retrospectively reviewed. The locations of the aneurysms included: 1 posterior choroidal artery(PChA), 2 posterior cerebral arteries(PCA), 3 superior cerebellar arteries(SCA), 4 anterior inferior cerebellar arteries(AICA), and 8 posterior inferior cerebellar arteries(PICA)in 6 patients. Results The parent arteries of 4 patients who received micro-coil embolization remained patent; the parent arteries of 7 patients who received Onyx with or without micro-coil were obstructed; the 7 aneurysms in 5 cases were clipped. Asymptomatic cerebellar infarction occurred in 3 cases. DSA or CTA follow-up in 11 cases showed no recurrence. Conclusion Due to the sufficient collateral circulation and anatomic variation, brain stem infarction resulted from occlusion is rarely seen. Saccular aneurysm in the front or outside of brain stem should be managed with parent artery preservation. Occlusion of the parent artery of aneurysms of the distal posterior circulation is safe and efficient.

Key words: Posterior circulation, Intracranial aneurysm, Parent artery occlusion

中图分类号:

R651

韩超,王成伟,丁璇,孟庆虎. 颅内后循环远端动脉瘤的外科治疗[J]. 山东大学学报（医学版）, 2016, 54(10): 66-70.

HAN Chao, WANG Chengwei, DING Xuan, MENG Qinghu. Surgical management of intracranial aneurysms of the distal posterior circulation[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(10): 66-70.

参考文献

[1] Schievink WI, Wijdicks EF, Piepgras DG, et al. The poor prognoses of ruptured intracranial aneurysms of the posterior circulation[J]. J Neurosurg, 1995, 82(5): 791-795.
[2] Lewis SB, Chang DJ, Peace DA, et al. Distal posterior inferior cerebellar artery aneurysms: clinical features and management[J]. J Neurosurg, 2002, 97(4): 756-766.
[3] Peluso JP, van Rooij WJ, Sluzewski M, et al. Distal aneurysms of cerebellar arteries: incidence, clinical presentation, and outcome of endovascular parent vessel occlusion[J]. AJNR Am J Neuroradiol, 2007, 28(8): 1573-1578.
[4] 梁国标, 高旭, 李志清, 等. Onyx栓塞治疗后循环远端动脉瘤及中期随访[J]. 中华神经外科杂志, 2012, 28(7): 651-654. LIANG Guobiao, GAO Xu, LI Zhiqing, et al. Intra-aneurysmal Onyx embolization for aneurysms of distal end of posterior circulation[J]. Chin J Neurosurg, 2012, 28(7): 651-654.
[5] Lv X, Li Y, Jiang C, et al. Parent vessel occlusion for P2 dissecting aneurysms of the posterior cerebral artery[J]. Surg Neurol, 2009, 71(3): 319-325.
[6] 王云彦,李学恩,李刚,等.小脑后下动脉远端动脉瘤的临床治疗[J]. 中华神经外科杂志, 2011, 27(12): 1202-1204. WANG Yunyan, LI Xueen, LI Gang, et al. Clinical treatment of aneurysm of distal part of posterior inferior cerebellar artery[J]. Chin J Neurosurg, 2011, 27(12): 1202-1204.
[7] 田道锋, 陈谦学, 张申起, 等. 小脑后下动脉远端动脉瘤的临床特征及手术治疗[J]. 中国临床神经外科杂志, 2011, 16(1): 1-3. TIAN Daofeng, CHEN Qianxue, ZHANG Shenqi, et al. Clinical characteristics and surgical treatment of distal posterior inferior cerebeilar artery aneurysms(a report of 8 cases)[J]. Chin J Clin Neurosurg, 2011, 16(1): 1-3.
[8] Lehto H, Harati A, Niemelä M, et al. Distal posterior inferior cerebellar artery aneurysms. clinical features and outcome of 80 patients[J]. World Neurosurg, 2014, 82(5): 702-713.
[9] Chalouhi N, Jabbour P, Starke RM, et al. Endovascular treatment of proximal and distal posterior inferior cerebellar artery aneurysms[J]. J Neurosurg, 2013, 118(5): 991-999.
[10] 汪阳, 洪涛. 小脑后下动脉远端动脉瘤的临床特点和显微外科治疗[J]. 中华医学杂志, 2013, 93(23): 1827-1829. WANG Yang, HONG Tao. Clinical characteristics and surgical treatment of distal posterior inferior cerebellar artery aneurysms[J]. Natl Med J China, 2013, 93(23): 1827-1829.
[11] 武琛,孙正辉,王芙昱,等.颅内远端动脉瘤的外科治疗[J].中华医学杂志, 2014, 94(9): 698-700. WU Chen, SUN Zhenghui, WANG Fuyu, et al. Surgical managements of peripheral intracranial aneurysms[J]. Natl Med J China, 2014, 94(9): 698-700.
[12] Matsushita Y, Kawabata S, Kamo M, et al. Ruptured aneurysm at the cortical segment of the posterior inferior cerebellar artery[J]. J Clini Neurosci, 2006, 13(7): 777-781.
[13] 王金荣, 王东昕, 高攀, 等. 小脑后下动脉远端多发动脉瘤一例[J]. 中华神经外科杂志, 2013, 29(6): 592.
[14] 孙正辉, 许百男, 姜金利, 等. 小脑前下动脉远端内听道内动脉瘤一例[J]. 中华神经外科杂志, 2005, 21(5): 273.
[15] Chalouhi N, Tjoumakaris S, Gonzalez LF, et al. Endovascular treatment of distal intracranial aneurysms with Onyx[J]. Clin Neurol Neurosurg, 2013, 115(12): 2528-2532.
[16] 陈左权, 张桂运, 顾斌贤, 等. 颅内后循环远端动脉瘤的介入治疗[J]. 中华神经外科杂志, 2007, 23(11): 837-839. CHEN Zuoquan, ZHANG Guiyun, GU Binxian, et al. Interventional therapy for distal aneurysms of intracranial arteries in the posterior circulation[J]. Chin J Neurosurg, 2007, 23(11): 837-839.

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颅内后循环远端动脉瘤的外科治疗

Surgical management of intracranial aneurysms of the distal posterior circulation

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