Wright D C, Wilson C B
Neurosurgery. 1979 Sep;5(3):325-33.
The surgical therapy and results in 17 cases of basilar aneurysms are reported, extending a series of 15 reported previously. Three surgical approaches were used: subtemporal, pterional, and suboccipital. The subtemporal route was satisfactory for most lesions, although the pterional approach has advantages for upper basilar aneurysms projecting either more than 1 cm above the dorsum sellae or directly anteriorly. A low lateral-suboccipital approach is described and recommended for aneurysms of the proximal basilar trunk and vertebrobasilar junction. The recent literature regarding surgical results, classification, pathogenesis, and technical developments for management of these lesions is reviewed. Most of the morbidity resulting from surgery in the midbrain and pontine region is due to direct or indirect injury to perforating vessels. Superiorly directed bifurcation aneurysms carry the highest risk because of their association with perforating vessels. General precepts regarding size, location, patient condition, and timing of operation with respect to aneurysms of the anterior circulation hold true for aneurysms of the posterior circulation.
本文报告了17例基底动脉瘤的手术治疗及结果，使此前报告的15例病例数得以增加。采用了三种手术入路：颞下、翼点和枕下。颞下途径对大多数病变效果良好，不过翼点入路对于位于鞍背上方超过1cm或直接向前突出的基底上部动脉瘤具有优势。本文描述并推荐了一种低位枕下外侧入路，用于治疗基底动脉近端和椎基底动脉交界处的动脉瘤。本文回顾了近期有关这些病变手术结果、分类、发病机制及治疗技术进展的文献。中脑和脑桥区域手术所致的大多数并发症是由于对穿支血管的直接或间接损伤。向上指向的分叉动脉瘤风险最高，因为它们与穿支血管有关。关于前循环动脉瘤的大小、位置、患者状况及手术时机的一般原则同样适用于后循环动脉瘤。
