頸椎或顱頸交界手術中椎動脈的損傷原因及處理

Vertebral artery injury in the cervical or craniocervical surgery: Risk factors and treatment

鄉志雄(XIANG Zhi Xiong) ； 廖挺(LIAO Ting) ； 黃登輝(Matthew Wong) ； 範耀華(FAN Yiu Wah) ； 陳麗晶(CHAN Lai Cheng)

《鏡湖醫學》 15卷2期 (2015/12) Pp. 64-66

摘要

目的：總結在神經外科手術中醫源性椎動脈損傷的原因及處理。方法：收集2010年5月～2015年4月實行的頸椎或顱頸交界處手術病人資料。結果：共126例病人實施頸椎或顱頸交界處手術，其中4例（佔3.33%）患者的椎動脈在手術過程出現損傷，3例病人進行椎動脈的修補手術，1例病人的椎動脈無法修補而直接結紮。結論：在後顱窩手術、顱頸交界手術及頸椎手術過程中，都有可能損傷到椎動脈。手術中直接修補是最有效的治療方法，而術前MRI或者CTA等檢查對避免損傷有很大的作用。熟悉椎動脈的解剖及變異對我們神經外科醫生非常重要。

關鍵字

椎動脈 ； 手術 ； 治療

並列摘要

Objective: To clarify the present incidence and management of iatrogenic VA injury during neurosurgical procedure. Methods: Our institutional surgical database was queried for patients who underwent cervical or craniocervical surgery form May 2010 to April 2015. Results: During this time period, 126 patients underwent cervical or craniocervical surgery and 4 (3.17%) cases of VA injury were identified. Primary microsurgical repair of the VA was performed in 3 patients. 1 patient had ligation. Conclusion: VA injury is an uncommon complication of cervical and/or skull base surgery. During the cervical or craniocervicalsurgical procedure, there may be damage to the vertebral artery. Direct surgical repair is the most effective treatment option. The most important preventative technique for VA injuries is preoperative MRI or CTA to detect VA anomalies. Such knowledge may be of use to the neurosurgeon.

並列關鍵字

Vertebral artery ； Operation ； Treatment