Seoane E R, Tedeschi H, de Oliveira E, Siqueira M G, Calderón G A, Rhoton A L
São Paulo Neurological Institute, University of São Paulo Medical School.
Acta Neurochir (Wien). 1997;139(4):325-31. doi: 10.1007/BF01808828.
In a period of 10 years fifteen patients bearing sixteen aneurysms arising at the posterior cerebral artery were operated at our institution. Based on the approaches selected for each location a division of the posterior cerebral artery into three surgical segments is proposed. The first segment (S1), or anterior extends from the basilar artery bifurcation to the point where the artery reaches the level of the most lateral edge of the cerebral peduncle, the second segment (S2), or middle extends from the posterior limit of S1 to a point located just before the most medial extent of the artery in the quadrigeminal cistern (collicular point), and the third segment (S3), or posterior corresponds to the collicular point and to the portions of the posterior cerebral artery distal to it. Utilizing the concept of surgical segments all aneurysms in our series were satisfactorily exposed. Those arising at the S1 segment (8 cases) were operated either through a pterional or a pretemporal approaches; those from the S2 segment (6 cases) were operated either via the subtemporal or the subtemporal transventricular routes; and that arising from the S3 segment (1 case) was managed through the occipital interhemispheric approach. Among the aneurysms eleven were small, one was large, and four were large or giant. Ten of these aneurysms were surgically clipped, two coagulated, three treated by trapping and in one case the aneurysm was resected and the posterior cerebral artery was reconstructed by a termino-terminal anastomosis. The surgical results were considered good in all cases but one, where the patient died due to clinical complications three months after surgery. It is our belief that the use of this classification can provide the means to best select the most appropriate surgical approach to treat aneurysms arising at the posterior cerebral artery.
在10年期间，我院对15例患有16个大脑后动脉动脉瘤的患者进行了手术。根据为每个部位选择的手术入路，建议将大脑后动脉分为三个手术节段。第一节段（S1），即前部，从基底动脉分叉处延伸至动脉到达大脑脚最外侧边缘水平的点；第二节段（S2），即中部，从S1的后缘延伸至位于四叠体池（丘脑部）动脉最内侧范围之前的一点；第三节段（S3），即后部，对应于丘脑部及其远端的大脑后动脉部分。利用手术节段的概念，我们系列中的所有动脉瘤都得到了满意的暴露。起源于S1节段的动脉瘤（8例）通过翼点入路或颞前入路进行手术；起源于S2节段的动脉瘤（6例）通过颞下入路或经颞下经脑室途径进行手术；起源于S3节段的动脉瘤（1例）通过枕部经半球间入路进行处理。在这些动脉瘤中，11个为小型，1个为大型，4个为大型或巨大型。其中10个动脉瘤进行了手术夹闭，2个进行了凝固治疗，3个采用了包裹术治疗，1例动脉瘤被切除，大脑后动脉通过端端吻合进行了重建。除1例患者术后3个月因临床并发症死亡外，所有病例的手术结果均被认为良好。我们认为，使用这种分类方法可以为最佳选择治疗大脑后动脉动脉瘤的最合适手术入路提供方法。
