Department of Neurosurgery, Cedars-Sinai Medical Center, 8631 West Third Street, Suit 800E, Los Angeles, CA 90048, USA.
J Clin Neurosci. 2012 Jan;19(1):144-8. doi: 10.1016/j.jocn.2011.07.013. Epub 2011 Nov 15.
While endovascular techniques play a significant and expanding role in the management of basilar trunk aneurysms, open surgical clipping remains necessary in select cases. Expanded endonasal transclival approaches offer the advantage of direct access and visualization of the midline vertebrobasilar system, benefits ideally suited to a basilar trunk aneurysm. A 59-year old woman with subarachnoid hemorrhage was found to have a ruptured basilar trunk aneurysm associated with a feeding vessel to a small cerebellar arteriovenous malformation (AVM). An expanded endoscopic endonasal transclival approach was used to successfully clip the basilar trunk aneurysm and feeding AVM vessel. The patient was subsequently discharged home without any neurological deficits. Transclival clipping of basilar trunk aneurysms is technically feasible and plays an important role in management when other strategies fail. The technical benefits of this approach include proximal and distal control of the basilar artery and improved visualization of the brainstem and perforators. Endoscopic transclival approaches should be considered in the management of complex basilar trunk aneurysms.
虽然血管内技术在基底动脉干动脉瘤的治疗中发挥着重要且不断扩大的作用，但在某些情况下仍需要进行开颅手术夹闭。扩大经鼻蝶入路提供了直接进入和可视化中线椎基底动脉系统的优势，非常适合基底动脉干动脉瘤。一名 59 岁女性因蛛网膜下腔出血被发现患有破裂的基底动脉干动脉瘤，该动脉瘤与小脑动静脉畸形（AVM）的供血血管有关。采用扩大内镜经鼻蝶入路成功夹闭基底动脉干动脉瘤和供血 AVM 血管。患者随后无任何神经功能缺损出院回家。当其他策略失败时，基底动脉干动脉瘤的经蝶入路夹闭在治疗中具有重要作用，并且技术上是可行的。该方法的技术优势包括基底动脉的近端和远端控制以及脑干和穿支血管的更好可视化。在处理复杂的基底动脉干动脉瘤时，应考虑内镜经蝶入路。
