小脑后下动脉远端动脉瘤的临床特点和显微外科治疗  

Clinical characteristics and surgical treatment of distal posterior inferior cerebellar artery aneurysms

作　　者：汪阳[1] 洪涛[1] 

机构地区：[1]南昌大学第一附属医院神经外科,330006

出　　处：《中华医学杂志》2013年第23期1827-1829,共3页National Medical Journal of China

基　　金：“十二五”国家科技支撑计划（2011BAI08B06）

摘　　要：目的探讨小脑后下动脉远端动脉瘤的临床特点和显微外科治疗。方法回顾性分析南昌大学第一附属医院2005年6月至2010年6月连续手术治疗的10例小脑后下动脉远端动脉瘤。其中男6例，女4例，年龄26—60岁，平均39．1岁。临床表现为出血9例，占位病变1例。所有患者术前做数字减影血管造影术（DSA）检查，6例CT血管造影（CTA）检查。所有患者经显微外科治疗，术式为枕下入路，手术夹闭6例，孤立3例，切除加血管端端吻合1例。结果DSA是诊断的主要手段，有2例合并小脑动静脉畸形。CTA检查有3例漏诊。无手术引起的死亡，术后1例并发颅内感染，1例脑积水行脑室腹腔分流术，随访2～5年，平均4．6年，无再次出血，改良Rankin量表（mRS）评分平均4．9分。结论小脑后下动脉远端动脉瘤诊断后显微外科手术治疗长期预后好．Objective To summarize the clinical characteristics and surgical treatment of distal posterior inferior cerebellar artery （ PICA ） aneurysms. Methods Ten consecutive cases of distal PICA aneurysms at our institute were retrospectively reviewed from June 2005 to June 2010. Among them, there were 6 males and 4 females with a mean age of 39. 1 （26 - 60） years. The clinical manifestations included intracranial hematoma （ n = 9 ） and mass effect （ n = 1 ）. All patients had computed tomography （CT） and digital subtraction angiography （DSA） scans while some of them received computed tomographie angiography （CTA） or magnetic resonance imaging （MRI） examinations. All patients underwent mierosurgical suboccipital eraniotomy. Results DSA was the main diagnostic tool. Eight patients had their aneurysms at left side and 2 at right side. The locations were at second section （ n = 2 ） , third section （ n = 2 ） , forth section （ n = 3 ） and fifth section （ n = 3 ）. And 2 cases were associated with arteriovenous maiformation at the same side. The diameters of aneurysms were 3 - 8.3 mm（ 〈 5 mm in 5, 5 - 10 mm in 5）. The outcomes included clipping （ n = 6 ） , trapping （ n = 3 ） and resection plus vessel anastomosis （ n = 1 ）. In all cases, treatment was successful without neurological deficits. One patient had postoperative complication of intraeranial infection and 1 patient with hydrocephalus underwent ventrieuiar-peritoneal shunt. All of them achieved excellent recovery. The mean follow-up period was 4. 6 years （range ：2 -5 ）. None of them suffered re-bleeding. And the mean modified Rankin scale scores was 4. 9. Conclusion Patients with distal PICA aneurysms may obtain excellent outcome after mierosurgery.

关 键 词：颅内动脉瘤 小脑后下动脉 显微神经外科 

分 类 号：R651[医药卫生—外科学]