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基底动脉远端动脉占颅内动脉瘤的5％～8％,多起源于基底动脉尖部,少数位于P_1、P_2 或小脑上动脉。作者报告1例初次脑血管造影阴性,再次脑血管造影显示的基底动脉远端动脉瘤,手术证实为基底动脉远端穿支动脉瘤并给予成功夹闭并保存穿支动脉血流。 患者,女,56岁, 突然出现严重的后枕部头痛,伴恶心、呕吐。检查:昏睡状态,颈项强直。CT扫描示SAH,病情为Hunt和HessⅢ级。初次四血管造影未显示动脉瘤,9d后重复血管造影为左小脑上动脉动脉瘤,直径约3mm,且造影剂灌注及排空缓慢。采用翼点入路开颅暴露基底动脉尖部,磨除后床突,充分暴露动脉瘤,见动脉瘤体与左小脑上动脉粘连,有穿支动脉在动脉瘤体中间通过,从动脉瘤体上分离该穿支动脉
Basilar artery distal artery accounts for 5% to 8% of intracranial aneurysms, mostly originated in the basilar artery apex, a few in the P_1, P_2 or the superior cerebellar artery. The authors report a case of a primary aneurysm of the basilar artery that had a negative initial cerebral angiogram and a second cerebral artery angiogram. The patient was proved to have a penetrating branch of the aneurysm distal to the basilar artery and was successfully occluded and preserved through the perforating branch artery. The patient, female, 56 years old, had a sudden severe occipital headache with nausea and vomiting. Check: lethargic state, neck stiffness. CT scan showed SAH, the disease was Hunt and Hess Ⅲ level. The first IVA did not show an aneurysm, and after 9 days repeat angiography was left superior cerebellar artery aneurysm with a diameter of about 3 mm and the contrast medium was infused and drained slowly. Pterional approach was used to expose the tip of the basilar artery in the craniotomy. After removal of the bed, the aneurysm was fully exposed. See the aneurysm and the left superior cerebellar artery. The perforator artery passed through the middle of the aneurysm, The perforator artery was separated