小脑后下动脉瘤经微血管多普勒超声辅助下的显微外科治疗

目的：探讨小脑后下动脉瘤（PICA）的微血管多普勒超声（MVD）辅助下显微外科治疗。方法：回顾性分析31例患者的显微外科手术的临床症状,影像特点,外科治疗方法及相关预后。结果：头颅CT表现主要为幕下为主的蛛网膜下腔出血或脑室出血或二者兼有（除1例未破裂）。其中经全脑数控减影血管造影术（DSA）和/或CT血管造影（CTA）检查确诊。其中手术路径为枕下旁正中16例,枕下正中入路14例,枕下乙状窦后入路1例。在MVD的辅助下行脉瘤夹闭术27例,动脉瘤包裹术1例,动脉瘤夹闭并动静脉畸形切除术2例,动脉瘤夹闭术并小脑血肿清除术1例。术后出现并发症10例,其中3例意识障碍致死亡或自动出院,其余患者术后无神经功能损伤或并发症,恢复良好。结论：小脑后下动脉瘤的治疗选择合适的手术入路行显微外科手术,辅助MVD下,能够降低手术风险,提高完全夹闭动脉瘤的成功率,降低手术并发症的发生。

Microsurgical Treatment of Posterior Inferior Cerebellar Aneurysms with the Assistance of Microvascular Doppler

Objective： To investigate the microsurgical treatment of aneurysms of the aneurysms of the posterior inferior cerebellar artery（PICA） which with the assistance of microvascular doppler（MVD）.Methods： The clinical data,including manifestations,the character of imageology,treatment and prognoses of 31 patients with aneurysm of the PICA.Results： All patients received microsurgery operation.The bleeding was confined to SAH（aubarachnoid hemorrhage） or/and the ventricular hemorrhage except one patient with unruptured aneurysms.The diagnosis was identified by preoperative DSA or/and CTA examination.The clinical data of 31 patients with PICA aneurysms,of whom,16 through lateral suboccipital approach,14 underwent microsurgery through the median suboccipital approach and 1 through suboccipital posterior sigmoid approach.Aneurysmal clipping were performed in 27 cases,aneurysmal wrapping in one case,aneurysmal clipping and evacuation of cerebellar hematoma in one case.TEN patients developed postoperative complication causing death in three cases with conscious disturbance.The rest of patients had good results.Conclusion： The appropriate surgical approach selection according to the location and shape of aneurysms and the assistant of MVD,may improve the success rate of aneurysmal clipping and reduce the postoperative complications.