显微手术治疗小脑后下动脉瘤的临床分析

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1、显微手术治疗小脑后下动脉瘤的临床分析江苏医药200()年第11期第26卷颅内动脉瘤作者：周岱王中崔岗周幽心张世明朱风清单位：苏州大学附属第一医院神经外科215006关键词：小脑后下动脉瘤脑室出血外科治疗【摘要】目的探讨小脑后下动脉瘤的影像学特征及外科治疗方案。方法冋顾性分析5例小脑后下动脉瘤的临床特点、彩像学特征及手术治疗效果。结杲5例中有4例因动脉瘤破裂出血而发病，CT检查均有第IV脑室出血；1例首发症状为步态不稳及后组颅神经不全性麻痹，经CT检查为后颅窝占位性病变。DSA检查对显示动脉瘤的具体部位及大小。5例均经后颅窝开颅显微手术治疗，其中动脉瘤蒂夹闭3

2、例，行动脉瘤加固术及孤立术各1例。5例中除1例术厉留有轻度偏瘫外，余4例恢复良好。结论小脑斤下动脉瘤多以第IV脑室出血发病，少数町以小脑及后组颅神经损害为首发症状，及早诊断和治疗，疗效是满意的。手术方式应尽量夹闭动脉瘤蒂，对夹层动脉瘤可采川加固术，少数无法夹闭瘤蒂者则行动脉瘤孤立术。ClinicalanalysisofposteriorinferiorcerebellaraneurysmstreatedwithmicrosurgeryZHOUDai,WANGZhong,CUIGang,etal.(DepartmentofNeurosurgery,TheFir

3、stAffilliatedHospitalofSuzhouUniversitySuzhou,215006)【Abstract1ObjectiveToexploreimagingcharacterandmicrosurgicaltreatmentofposteriorinferiorcerebellaraneurysms.MethodsRetrospectiveanalysisofclinicalandimagingcharacterandtheresultsofmicrosurgicaltreatmentin5casesofposteriorinferior

4、cerebellaraneurysms.ResultsFourcasesofruptureofaneurysmsandCTfindingsrevealedthefourthventricularhemorrhage：onecaseexperiencedrunningdisorderandincompleteparalysisofcranialnerveandCTscanconfirmedmassivelesioninposteriorfossa.DSAexaminationmayrevealthesizeandpositionofaneurysms.All5

5、patientsweretreatedbymicrosurgicaloperatiomAmongthemthreereceivedaneurysmalclip,onehadwrapping,andthereminingoneunderwentprosicalocclusionofposteriorinteriorcerebellarartery.Fourcaseshadgoodresultsandonecasehadslighthemiplegia・ConclusionMostofposteriorinferiorcerebellaraneurysmsare

6、complicatedwiththefourthventricularhemorrhageandafewoccurredwithdamageofcerebellarfunctionandlatergroupsofcranialnerves.Theoutcomeisgoodbyearlierdiagnosisandoperation.Thewrappingisusuallyusedinpatientswithdissectinganeurysmsandtheproximalocclusionofposteriorinferiorcerebellaratrter

7、yisusedinpatientsinwhomclippingiscountraindicated.【Keywords]PosteriorinteriorcerebellaraneurysmVentricularhemorrhageMicrosurgicaltreatment小脑后下动脉瘤临床上较少见，临床医师对其特征性表现缺乏认识，故常易导致漏诊。我院1995年1月〜1999年2月收治5例，经及时诊断和手术治疗效果满意，现报告如下。临床资料一、一般资料：男3例，女2例，平均年龄39岁。4例以出血为首发症状，表现为突发性头痛伴恶心、呕叶，术前Hum分级：II

8、级3例，III级1例。其屮1例伴有轻度意识障碍。另1