中国脑血管病杂志2017，Vol.14Issue(5)：267-272,6.DOI:10.3969/j.issn.1672-5921.2017.05.009
采用枕下肌肉分层法远外侧入路治疗椎-基底动脉瘤
Treatment of vertebrobasilar aneurysms using suboccipital muscle stratification via far lateral approach
孙力泳 1李桂林 1李茗初 1马妍 1胡鹏 1何川 1张鸿祺1
作者信息
- 1. 100053 北京,首都医科大学宣武医院神经外科
- 折叠
摘要
Abstract
Objective To discuss the technical essentials of microsurgery using suboccipital muscle stratification for the treatment of complex vertebrobasilar aneurysms via far lateral approach.Methods The clinical data of 8 patients with vertebrobasilar aneurysm underwent suboccipital muscle stratification via far lateral approach at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively,including 5 patients with subarachnoid hemorrhage (Hunt-Hess grade Ⅱ 3 cases;grade Ⅲ 1 case;grade Ⅳ 1 case),and 3 with symptomatic dissecting aneurysm.Six patients underwent occipital artery-posterior inferior cerebellar artery and anterior inferior cerebellar artery bypass grafting,and aneurysm trapping,and the aneurysms of the other 2 cases were clipped directly in the operation.The modified Rankin scale (mRS) was used to evaluate the clinical efficacy.Results Postoperative digital subtraction angiography (DSA) revealed that all the bridge vessels were patent.The obtained length of occipital artery in the actual measurement of the operation was 12.5±1.1 cm.The distance between the anastomosis site and the skin incision in 6 cases was 50±6 mm.They were followed up for 4-21 months after procedure.The mRs score in 7 cases was 0-1.Two patients had new-onset hoarseness and recovered completely within 3 months after procedure.Another patient had postoperative cerebellar hemisphere dominant regional cerebral infarction and the mRs score was 4.None of them had poor wound healing,infection and cerebrospinal fluid leakage after procedure.Conclusion Suboccipital muscle stratification via far lateral approach can effectively obtain a longer occipital artery,reduce the occupation effect of muscle and depth of field.It is beneficial to expose lesions and operation of deep anastomosis.It is a more safe and practical technique in neurosurgery for the treatment of vertebrobasilar artery aneurysms.关键词
颅内动脉瘤/椎-基底动脉/枕动脉/动脉旁路移植术/远外侧入路Key words
Intracranial aneurysm/Vertebrobasilar artery/Occipital artery/Bypass/Far lateral approach引用本文复制引用
孙力泳,李桂林,李茗初,马妍,胡鹏,何川,张鸿祺..采用枕下肌肉分层法远外侧入路治疗椎-基底动脉瘤[J].中国脑血管病杂志,2017,14(5):267-272,6.
