Drake C G
J Neurosurg. 1975 Sep;43(3):255-74. doi: 10.3171/jns.1975.43.3.0255.
The author reports the use of vertebral artery ligation, unilateral and bilateral, for the treatment of large vertebral-basilar aneurysms in 14 patients with one delayed death. Extracranial ligation was carried out unilaterally with a Selverstone clamp in three patients. In two, where the aneurysm filled only from one vertebral artery, there was extensive thrombosis within the sac and dramatic clinical improvement after decompression. Extracranial ligation was done bilaterally in three patients, temporarily in two. A 14-year-old boy is well after 5 years but the bilateral vertebrobasilar aneurysm did not undergo extensive thrombosis until both vertebral arteries were occluded at their intracranial entrance above collateral flow. In two others, the clamp had to be reopened on the second artery. In one patient, death from delayed thrombosis of a huge aneurysm and pontine infarction might have been prevented with anticoagulants. In the other, the aneurysm ruptured again fatally 18 months later. Unilateral intracranial occlusion of a vertebral artery was done in eight cases, with no morbidity and complete or nearly complete thrombosis in all but one aneurysm. Seven patients had excellent or good results while one showed little recovery from an existing medullary syndrome. Occlusion of the basilar artery was done in seven cases. In five it was used deliberately as the only treatment, but in two it was forced when an aneurysm burst during dissection. Only two of the patients in the first group and one of the second group have made complete recoveries. The results of vertebral artery occlusion are encouraging and the technique deserves further consideration. Extensive collateral circulation enhances the safety of cervical vertebral artery occlusion but can be of a degree to make the occlusion ineffective. For intracranial occlusion knowledge of the size and distribution of each vertebral artery is essential. Occlusion of the basilar artery is dangerous, although it seems to be effective in producing extensive thrombosis in the aneurysm. It should probably be done under anesthesia only when the artery fills spontaneously from the carotid circulation. Otherwise, even when reasonable posterior communicating arteries are demonstrated, it is best to test occlusion under local anesthesia.
作者报告了采用单侧和双侧椎动脉结扎术治疗14例大型椎基底动脉瘤患者的情况，其中1例患者延迟死亡。3例患者采用塞尔弗斯通夹进行单侧颅外结扎。在2例动脉瘤仅由一侧椎动脉供血的患者中，瘤腔内出现广泛血栓形成，减压后临床症状显著改善。3例患者进行了双侧颅外结扎，其中2例为临时结扎。一名14岁男孩在5年后情况良好，但双侧椎基底动脉瘤在双侧椎动脉在颅内入口处高于侧支循环的位置被闭塞后才出现广泛血栓形成。另外2例患者，第二条动脉的夹子不得不重新打开。1例患者因巨大动脉瘤延迟血栓形成和脑桥梗死死亡，使用抗凝剂可能可预防。另1例患者，动脉瘤在18个月后再次破裂并致命。8例患者进行了单侧颅内椎动脉闭塞术，无一例出现并发症，除1例动脉瘤外，其余均完全或几乎完全形成血栓。7例患者效果极佳或良好，1例患者髓质综合征恢复不佳。7例患者进行了基底动脉闭塞术。其中5例是故意将其作为唯一治疗方法，但2例是在解剖过程中动脉瘤破裂时被迫进行的。第一组患者中只有2例、第二组患者中只有1例完全康复。椎动脉闭塞术的结果令人鼓舞，该技术值得进一步研究。广泛的侧支循环增强了颈椎椎动脉闭塞术的安全性，但程度可能会使闭塞无效。对于颅内闭塞，了解每条椎动脉的大小和分布至关重要。基底动脉闭塞术很危险，尽管它似乎能有效在动脉瘤内形成广泛血栓。仅当动脉从颈动脉循环自发充盈时，才可能应在麻醉下进行。否则，即使显示出合理的后交通动脉，最好在局部麻醉下进行闭塞试验。
