小脑后下动脉动脉瘤的诊断和治疗  

Diagnosis and treatment of posterior inferior cerebellar aneurysms

作　　者：唐晓平[1] 余定庸[1] 毛伯镛[2] 游潮[2] 张跃康[2] 彭华[1] 唐文国[1] 漆建[1] 罗仁国[1] 冯凌[1] 王远传[1] 苟章洋[1] 杨新建[3] 

机构地区：[1]川北医学院附属医院神经外科,南充市637000 [2]四川大学华西医院神经外科 [3]北京市神经外科研究所

出　　处：《中华神经外科杂志》2007年第11期823-825,共3页Chinese Journal of Neurosurgery

摘　　要：目的探讨小脑后下动脉动脉瘤的临床特征、诊断、鉴别诊断和治疗。方法回顾性分析12例小脑后下动脉瘤的临床表现、影像学特征、手术效果及诊治过程中存在的相关问题。结果12例中有11例因动脉瘤破裂出血而发病,单纯第四脑室出血4例,全脑室系统出血2例,小脑半球出血3例,小脑蚓部伴第四脑室出血1例,侧脑室伴第三脑室出血1例,以后颅窝占位病变表现1例。8例术前行DSA检查明确诊断,4例术中明确诊断。12例均行后颅窝开颅显微手术治疗,其中动脉瘤颈夹闭9例,孤立切除2例,动脉瘤加固术1例,术后2例因脑积水加重行脑室-腹腔分流术。12例中除1例术后留有轻偏瘫外,其余11例恢复良好。结论小脑后下动脉瘤多以第四脑室出血发病,少数以小脑半球或蚓部出血发病,及早治疗效果满意。手术方式应尽量夹闭动脉瘤颈,对于小脑后下动脉末端动脉瘤,可以采用孤立切除术。Objective To investigate the clinical feature, differential diagnosis and treatment of posterior inferior cerebellar aneurysms. Methods Retrospectively analyze the clinical manifestation, the character of imageology and the results of microsurgical treatment in 12 cases of posterior inferior cerebellar aneurysms. Results Out of 12 cases, 11 cases belonged to the rupture of aneurysms, 4 cases belonged to the pure Ⅳ ventricular hemorrhage, 2 cases belonged to the whole ventricular systems hemorrhage, 3 cases related with cerebellar hemisphere hemorrhage, 1 case related with cauda cerebelli and the Ⅳ ventricular hemorrhage, 1 case related with lateral cerebral ventricle and m ventricular hemorrhage, and one case displayed pathological changes in posterior cranial fossa. The diagnosis was identified by preoperative DSA examination in 8 cases and by operation in 4 cases. All 12 patients were treated by microsurgical operation, in which 9 cases received aneurysm clipping, one wrapped, two isolated and ablated, two cases treated by V-P shunt owing to serious hydrocephalus. 11 cases had good results and one case had slight hemiplegia. Conclusion Most of posterior interior cerebellar aneurysms are complicated with the Ⅳ ventricular hemorrhage, which also related with agnogenic cerebellum hematoma and cauda cerebelli hemorrhage. The outcome is good by earlier DSA examination and microsurgical operation. The main operating method is to clip the neck of aneurysm. For the aneurysm located on the end of posterior inferior cerebellar artery, the aneurysm isolating and removal can be applied.

关 键 词：颅内动脉瘤 小脑后下动脉 脑室出血 显微外科治疗 

分 类 号：R651.12[医药卫生—外科学]