Zhitao Jing, Yibao Wang, Anhua Wu, Shaowu Ou, Yunchao Ban, Renyi Zhou, Yunjie Wang
Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Shenyang 110001, China.
Neurol India. 2010 Mar-Apr;58(2):242-7. doi: 10.4103/0028-3886.63806.
Aneurysms arising from the P(2) segment of the posterior cerebral artery (PCA) are rare, accounting for less than 1% of all intracranial aneurysms. To date, few studies concerning the management of P(2) segment aneurysms have been reported.
To review the microsurgical techniques and clinical outcomes of microsurgical treatment by different approaches in patients with aneurysms on the P(2) segment of the PCA.
Forty-two patients with P2 segment aneurysms had microsurgical treatment by subtemporal approach. All the patients had drainage of cerebrospinal fluid for decompression, and indocyanine green (ICG) angiography was used in 20 patients to assess the effect of clipping.
Of the 42 patients, 16 were operated by combined pterional-subtemporal approach. In 40 patients aneurysms were successfully treated by clipping the P(2) aneurysmal neck while preserving the parent artery. Two patients with giant aneurysms were treated using surgical trapping. Postoperatively, 41 patients had a good recovery. One patient after aneurysm trapping had ischemic infarction in the PCA tertiary and presented with hemiparesis and homonymous hemianopia. However, this patient recovered after three weeks of treatment.
Subtemporal approach is the most appropriate approach to clip the aneurysms of the P(2) segment. It allows the neurosurgeon to operate on the aneurysms while preserving the patency of the parent artery. Gaint P(2) segment aneurysms can safely be treated by rapping of the aneurysm by combined subtemporal or pterional-subtemporal approach in experienced hands. ICG angiography will be an important tool in monitoring for the presence of residual aneurysm or perforating artery occlusion during aneurysm clipping. Preoperative lumbar drainage of cerebrospinal fluid may help to avoid temporal lobe damage.
大脑后动脉（PCA）P2段动脉瘤较为罕见，占所有颅内动脉瘤的比例不到1%。迄今为止，关于P2段动脉瘤治疗的研究报道较少。
回顾经不同入路显微手术治疗PCA P2段动脉瘤患者的显微手术技术及临床结果。
42例P2段动脉瘤患者采用颞下入路进行显微手术治疗。所有患者均行脑脊液引流减压，20例患者使用吲哚菁绿（ICG）血管造影评估夹闭效果。
42例患者中，16例采用翼点 - 颞下入路联合手术。40例患者通过夹闭P2段动脉瘤颈成功治疗动脉瘤，同时保留载瘤动脉。2例巨大动脉瘤患者采用手术包裹治疗。术后，41例患者恢复良好。1例动脉瘤包裹术后患者PCA三级分支出现缺血性梗死，表现为偏瘫和同向性偏盲。然而，该患者经三周治疗后恢复。
颞下入路是夹闭P2段动脉瘤最合适的入路。它使神经外科医生能够在保留载瘤动脉通畅的同时对动脉瘤进行手术。在经验丰富的医生手中，通过联合颞下或翼点 - 颞下入路包裹巨大的P2段动脉瘤可安全治疗。ICG血管造影将是监测动脉瘤夹闭过程中残余动脉瘤或穿支动脉闭塞情况的重要工具。术前腰椎脑脊液引流可能有助于避免颞叶损伤。
