【摘要】：目的 探討顯微外科手術采用枕下肌肉分層法遠外側入路治療復雜椎-基底動脈瘤的技術要點。方法 回顧性分析2015年8月至2017年1月首都醫(yī)科大學宣武醫(yī)院采用枕下肌肉分層法遠外側入路治療的8例椎-基底動脈瘤患者的臨床資料,其中5例為蛛網(wǎng)膜下腔出血(HuntHess分級Ⅱ級3例、Ⅲ級1例、Ⅳ級1例),3例為癥狀性夾層動脈瘤。對6例患者行枕動脈-小腦后下動脈或小腦前下動脈旁路移植術及動脈瘤孤立術,另2例在術中直接夾閉動脈瘤。分析術野暴露情況,以改良Rankin量表(mRS)評價臨床療效。結果 術后DSA檢查示橋血管均通暢。術中實際測量枕動脈獲取長度為(12.5±1.1)cm;6例旁路移植的吻合深度為(50±6)mm。術后隨訪4~21個月,7例患者mRS評分0~1分,2例新發(fā)聲音嘶啞,術后3個月內完全恢復;另1例術后小腦半球支配區(qū)域腦梗死,mRS評分4分。無一例發(fā)生術后傷口愈合不良、感染及腦脊液漏。結論 枕下肌肉分層法遠外側入路,可有效地獲取較長的枕動脈,減少了肌肉的占位效應和增加術野深度,利于病變顯露及深部吻合手術操作,是神經外科治療椎-基底動脈瘤較為安全實用的技術方法。
[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 鹵1. 1) cm;6. The anastomotic depth of bypass transplantation was (50 鹵6) mm.. The follow-up period was 4 鈮，

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