采用枕下肌肉分层法远外侧入路治疗椎-基底动脉瘤
发布时间：2019-07-10 12:12
【摘要】：目的 探讨显微外科手术采用枕下肌肉分层法远外侧入路治疗复杂椎-基底动脉瘤的技术要点。方法 回顾性分析2015年8月至2017年1月首都医科大学宣武医院采用枕下肌肉分层法远外侧入路治疗的8例椎-基底动脉瘤患者的临床资料,其中5例为蛛网膜下腔出血(HuntHess分级Ⅱ级3例、Ⅲ级1例、Ⅳ级1例),3例为症状性夹层动脉瘤。对6例患者行枕动脉-小脑后下动脉或小脑前下动脉旁路移植术及动脉瘤孤立术,另2例在术中直接夹闭动脉瘤。分析术野暴露情况,以改良Rankin量表(mRS)评价临床疗效。结果 术后DSA检查示桥血管均通畅。术中实际测量枕动脉获取长度为(12.5±1.1)cm;6例旁路移植的吻合深度为(50±6)mm。术后随访4~21个月,7例患者mRS评分0~1分,2例新发声音嘶哑,术后3个月内完全恢复;另1例术后小脑半球支配区域脑梗死,mRS评分4分。无一例发生术后伤口愈合不良、感染及脑脊液漏。结论 枕下肌肉分层法远外侧入路,可有效地获取较长的枕动脉,减少了肌肉的占位效应和增加术野深度,利于病变显露及深部吻合手术操作,是神经外科治疗椎-基底动脉瘤较为安全实用的技术方法。
[Abstract]:Objective to investigate the key points of microsurgery in the treatment of complex vertebrobasilar aneurysm by distal lateral approach of suboccipital muscle stratification. Methods the clinical data of 8 patients with vertebrobasilar aneurysm treated by distal lateral approach of suboccipital muscle stratification in Xuanwu Hospital of Capital University of Medical Sciences from August 2015 to January 2017 were analyzed retrospectively. among them, 5 patients were subarachnoid hemorrhage (HuntHess grade II 3 cases, grade III 1 case, grade IV 1 case) and 3 cases were symptomatic dissecting aneurysm. Occipital artery posterior inferior cerebellar artery or anterior inferior cerebellar artery bypass grafting and aneurysm isolation were performed in 6 patients, and the aneurysm was directly clipped in the other 2 cases. The exposure to surgical field was analyzed and the clinical efficacy was evaluated by modified Rankin scale (mRS). Results DSA showed that the bridge vessels were unobstructed after operation. The actual length of occipital artery obtained during operation was (12. 5 卤1. 1) cm;6. The anastomotic depth of bypass transplantation was (50 卤6) mm.. The follow-up period was 4 鈮，
本文编号：2512598
[Abstract]:Objective to investigate the key points of microsurgery in the treatment of complex vertebrobasilar aneurysm by distal lateral approach of suboccipital muscle stratification. Methods the clinical data of 8 patients with vertebrobasilar aneurysm treated by distal lateral approach of suboccipital muscle stratification in Xuanwu Hospital of Capital University of Medical Sciences from August 2015 to January 2017 were analyzed retrospectively. among them, 5 patients were subarachnoid hemorrhage (HuntHess grade II 3 cases, grade III 1 case, grade IV 1 case) and 3 cases were symptomatic dissecting aneurysm. Occipital artery posterior inferior cerebellar artery or anterior inferior cerebellar artery bypass grafting and aneurysm isolation were performed in 6 patients, and the aneurysm was directly clipped in the other 2 cases. The exposure to surgical field was analyzed and the clinical efficacy was evaluated by modified Rankin scale (mRS). Results DSA showed that the bridge vessels were unobstructed after operation. The actual length of occipital artery obtained during operation was (12. 5 卤1. 1) cm;6. The anastomotic depth of bypass transplantation was (50 卤6) mm.. The follow-up period was 4 鈮，
本文编号：2512598
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