Wang Wen-Xin, Xu Bai-Nan, Wang Fu-Yu, Wu Chen, Sun Zheng-Hui
Department of Neurosurgery, Chinese PLA General Hospital , Beijing , P. R. China.
Br J Neurosurg. 2015 Jun;29(3):406-12. doi: 10.3109/02688697.2015.1004301. Epub 2015 Feb 20.
We reviewed a series of 30 cases of posterior cerebral artery (PCA) aneurysms to examine the outcomes of microsurgical techniques, which is an important alternative to endovascular interventions in localities where access to the latter renders practical difficulty. We also aimed to introduce the initial experience about the clinical application of intraoperative computed tomography (CT) in treatment of PCA aneurysm.
Thirty patients with PCA aneurysm treated using microsurgery in our department between January 1996 and July 2014 were reviewed retrospectively.
The case series included 13 females and 17 males with a mean age of 44 years, ranging from 8 to 78 years. Eighteen aneurysms were ruptured, five aneurysms caused a direct mass effect, and the remaining seven aneurysms were found incidentally. Most aneurysms were located in the P1 segment or the P1-P2 junction of the PCA (63%). Eighteen aneurysms (60%) were large or giant in size (≥ 10 mm). Seventeen aneurysms were directly clipped, six trapped, one wrapped, one electrocoagulated and resected, and five trapped or proximal clipped with a bypass. Intraoperative perfusion CT (PCT) and CT angiography (CTA) were applied to provide immediate information regarding cerebral hemodynamics and anatomy of vessels in six patients. Twenty-six patients (87%) showed good clinical outcomes according to the modified Rankin Scale score (≤ 2) at the mean clinical follow-up period of 34 (range: 1-78) months, including the patients using intraoperative CT, and one (3%) patient was dead.
Microsurgical therapy for patients with PCA aneurysms can have a positive outcome with correctly selected techniques. Personalized microsurgical treatment paradigms are determined by the anatomical location, shape and size of the PCA aneurysm, and the clinical features of the patient. Intraoperative PCT and CTA can improve the efficacy of the surgical treatment.
我们回顾了一系列30例大脑后动脉（PCA）动脉瘤病例，以研究显微外科技术的治疗效果，在难以进行血管内介入治疗的地区，显微外科技术是一种重要的替代方法。我们还旨在介绍术中计算机断层扫描（CT）在PCA动脉瘤治疗中的临床应用的初步经验。
回顾性分析1996年1月至2014年7月在我科采用显微外科手术治疗的30例PCA动脉瘤患者。
该病例系列包括13名女性和17名男性，平均年龄44岁，年龄范围为8至78岁。18例动脉瘤破裂，5例动脉瘤产生直接占位效应，其余7例动脉瘤为偶然发现。大多数动脉瘤位于PCA的P1段或P1-P2交界处（63%）。18例（60%）动脉瘤为大型或巨大型（≥10mm）。17例动脉瘤直接夹闭，6例采用包裹术，1例电凝切除，1例包裹并切除，5例采用包裹或近端夹闭并搭桥。6例患者术中应用灌注CT（PCT）和CT血管造影（CTA）以提供有关脑血流动力学和血管解剖的即时信息。在平均34个月（范围：1-78个月）的临床随访期，根据改良Rankin量表评分（≤2），26例（87%）患者临床预后良好，包括使用术中CT的患者，1例（3%）患者死亡。
对于PCA动脉瘤患者，采用正确选择的技术进行显微外科治疗可取得良好效果。个性化的显微外科治疗模式取决于PCA动脉瘤的解剖位置、形态和大小以及患者的临床特征。术中PCT和CTA可提高手术治疗效果。
