【作者】 李伟华；

【导师】 孙丕通；

【作者基本信息】 大连医科大学 ， 外科学， 2005， 硕士

【摘要】 目的 颅内微动脉瘤由于体积小,诊断困难,过去国内外虽有研究但无大的进展,本文探讨颈内动脉-后交通动脉起始部微动脉瘤的诊断和治疗方法,以及该部位的微动脉瘤与后交通动脉起始部漏斗样膨大的鉴别方法。 方法 对 2000～2004 年 14 例经手术证实的颈内动脉-后交通动脉起始部微动脉瘤进行临床研究,分析其临床表现,术前影像学(主要是 CT、DSA)资料,术中情况; 观察重叠征、错位征、胎儿型大脑后动脉、胎儿型后交通动脉在后交通动脉起始部微动脉瘤的诊断中的意义。 结果 14 例患者均以头痛为首发症状,Hunt-Hess 分级均Ⅳ级以下,均无动眼神经麻痹征象,Fisher-CT 分级Ⅰ级 9 例,Ⅱ级 3 例,Ⅲ级 1例,Ⅳ级 1 例; 14 例患者共发现动脉瘤 16 个,多发动脉瘤 2 例;术前经 DSA 明确诊断的微动脉瘤有 13 例,其中显示重叠征的有 13 例,所有病例均具备错位征;胎儿型后交通动脉有 8 例,胎儿型大脑后动脉 5 例。全部行开颅颅内动脉瘤夹闭术,术后 GOS 评分均为 5 分。 结论 微动脉瘤引起的蛛网膜下腔出血出血量常较少,数字减影血管造影表现的重叠征和错位征对微动脉瘤的诊断尤其是对后交通动脉起始部膨大的鉴别有重要意义;采用经发迹内翼点锁孔入路手术治疗效果满意。更多还原

【Abstract】 Objective As micro-aneurysm had small volume, it was difficult todiagnosis before operation. There had been studied by the scholars ofinternal or overseas, but had little success. This paper was to investigate thediagnosis and treatment of the micro-aneurysm of posterior communicatingartery section start, and studied the ways to distinguish the micro-aneurysmfrom the IFS of P-ComA.. Methods 14 patients with the micro-aneurysm of P-ComA wereincluded from 2000～2004 proved by operation, and studied the features ofclinic、 angiogram(CT and DSA) and operation. We researched signs ofintersect 、superposition、fetal posterior communicating artery、fetalposterior cerebral artery, and studied the exhibition on the diagnosis of themicro-aneurysm of P-ComA section start. Result Headache is the first symptom of all 14 cases. The grade ofHunt-Hess were all under in the Ⅳ grade, no one had the oculomotornucleus paralysis, Fisher-CT grade Ⅰwas 9,Ⅱ was 3,Ⅲ was 1,Ⅳ was1 .There were 13 cases proved before operation, all the cases had the signof intersect ,13 cases had the sign of superposition; fetal posteriorcommunicating artery were 8,fetal posterior cerebral artery were 5. All thecases were clipped through operation, The GOS were all on the 5. Conclusion The capacity of SAH from micro-aneurysm were small.The intersect and superposition is the special performance on theangiogram of micro-aneurysm. It was a satisfactory result through directmicrosurgery treatment via the minimum invasive technique pterionalapproach within the hair edge.更多还原