后交通动脉镜像动脉瘤的影像学特征及手术疗效

目的探讨后交通动脉（PCoA）镜像动脉瘤的影像学特征、手术时机与方法，以及显微外科手术的疗效。方法回顾性分析显微外科手术治疗的8例（16个）PCoA镜像动脉瘤患者的临床资料。采取早期与择期、一期与二期相结合的方法处理PCoA镜像动脉瘤。原则是先处理破裂动脉瘤，再处理未破裂动脉瘤。结果①PCoA镜像动脉瘤均位于颈内动脉一后交通动脉的分叉处，两侧动脉瘤的大小、形态完全对称（Ⅰ型）的有6例，不完全对称（Ⅱ型）的有2例。动脉瘤大小：0．5～1．5cm的有9个，〉1．5—2．0cm的有5个，〉2．0cm的有2个。入院时Hunt—Hess分级Ⅱ级的有2例，Ⅲ级的有4例，Ⅳ级的有2例。②直接夹闭PCoA镜像动脉瘤15个，未处理的有1个。一期手术5例，均经双侧开颅，夹闭PCoA动脉瘤10个，对其中2例同时清除脑内血肿。二期手术2例，第1次手术夹闭一侧PCoA动脉瘤2个，对其中1例同时清除脑内血肿，第2次手术夹闭另一侧PCoA动脉瘤2个。夹闭一侧PCoA动脉瘤后，对侧动脉瘤未处理者1例。③依据格拉斯哥预后评分：良好的有6例，轻残的有1例，重残的有1例。随访3～48个月，动脉瘤无复发。结论显微外科手术治疗PCoA镜像动脉瘤效果显著，将PCoA镜像动脉瘤分为Ⅰ型和Ⅱ型，有助于判断出血的责任动脉瘤；根据动脉瘤的形态、患者Hunt-Hess分级及周身状况等选择一期或二期手术，可达到良好的效果。

Neuroradiological characteristics and surgical efficacy of mirror-image aneurysms of posterior communicating artery

Objective To investigate the neuroradiologieal characteristics, surgical timing and microsurgieal treatment of posterior communicating artery （PCoA） mirror-image aneurysms. Methods The clinical data of 8 patients with 16 mirror-image aneurysms of PCoA treated with microsurgery were analyzed retrospectively. The mirror-image aneurysms of PCoA were treated by using early or late stage and one or two-stage operation. The principle was to treat the ruptured aneurysms first. Results ①All the mirrorimage aneurysms of PCoA located in the bifurcations of internal carotid artery （ICA） and the PCoA. The size and shape of the aneurysms on both sides were symmetrical （ type Ⅰ ） in 6 cases, and unsymmetrical （type Ⅱ ） in the other 2 cases. The size was 0. 5 - 1.5 em in 9 aneurysms, 〉 1.5 - 2. 0 cm in 5 aneurysms,and 〉 2.0 cm in 2 aneurysms. The Hunt-Hess grade Ⅱ in 2 cases, grade Ⅲ in 4 cases, and grade Ⅳ in 2 cases on admission. ②Fifteen mirror-image aneurysms of PCoA were clipped directly and one was not treated. Five patients underwent one-stage operation, through bilateral eraniotomy. Ten aneurysms of PCoA were clipped, and the intracerebral hematomas in 2 patients were evacuated at the same time ; two patients underwent two stage operation, 2 aneurysms were clipped at the first operation, The other 2 aneurysms were clipped at the second operation. The aneurysm was clipped on one side, the aneurysm on opposite side was not treated in 1 case. ③According to the determination of Glasgow Outcome Scale scores, the prognosis of 6 cases was excellent, 1 had mild and 1 had severe disability. The patients were followed up for 3 to 48 months and no recurrence of aneurysm was observed. Conclusion The efficacy of microsurgical treatment of mirror-image aneurysms of PCoA was significant. The mirror-image aneurysms of PCoA were divided into type Ⅰ and type Ⅱ , and it contributed to identify the guilty aneurysms of bleeding. According to the shape of aneurysm, Hunt-Hess grade and systemic conditions of the patients, choosing oneor two-stage operation may achieve good results.