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作者对不能进行瘤颈夹闭术的破裂椎动脉瘤患者采用近端夹闭术,手术前后进行三维CT血管造影(3DCTA),观察动脉瘤的消失情况,椎基底动脉血流动态改变等,并与脑血管造影结果进行比较。患者6例,男5例,女1例,年龄33～61岁,平均47.8岁。均以SAH发病,术前脑血管造影显示囊状动脉瘤1例,纺锤状动脉瘤5例,其中右椎动脉瘤4例,左椎动脉瘤2例。有2例于发病4日内手术,其余4例择期手术。6例中有4例于PICA远端夹闭,有2例因动脉瘤靠近PICA起始部。故于PICA近端夹闭。愈后良好者5例,严重功能缺失1例。
The authors used proximal clipping in patients with ruptured vertebral aneurysms that could not undergo neck clipping and performed three-dimensional computed tomography angiography (3DCTA) before and after surgery to observe the disappearance of aneurysms and the dynamic changes of vertebrobasilar flow. Compared with cerebral angiography results. 6 patients, 5 males and 1 females, aged 33 to 61 years, an average of 47.8 years old. All of them were diagnosed by SAH. One case of cystic aneurysm and 5 cases of spindle aneurysm were diagnosed by preoperative cerebral angiography, including 4 cases of right vertebral aneurysm and 2 cases of left vertebral aneurysm. There are 2 cases in the onset of surgery within 4 days, the remaining 4 cases of elective surgery. Of the 6 cases, 4 were occluded at the distal end of PICA and 2 were located near the beginning of PICA due to aneurysm. It is closed at the proximal PICA. 5 cases of good after healing, 1 case of severe loss of function.