小脑后下动脉动脉瘤的血管内治疗与手术治疗(附21例报道)  

Endovascular embolization and microsurgery of posterior inferior cerebellar artery aneurysms(report of 21 cases)

作　　者：廖旭兴[1,2] 蔡瑜[3] 王辉[3] 梁学军[3] 段成斌 胡建军 邓其峻[3] 马廉亭[1] 

机构地区：[1]广州军区武汉总医院神经外科,武汉430070 [2]佛山市第一人民医院 [3]佛山市第一人民医院神经外科,广东528000 [4]佛山市第六人民医院神经外科,广东528000

出　　处：《中国临床神经外科杂志》2015年第6期329-331,共3页Chinese Journal of Clinical Neurosurgery

基　　金：广东省佛山市医学科技攻关项目(20111021000641;201208047;201308089);广东省佛山市卫生局科研立项课题(2011042)

摘　　要：目的：探讨小脑后下动脉（PICA）动脉瘤的血管内治疗与手术治疗效果。方法回顾性分析21例PICA动脉瘤患者的临床资料，其中近侧段11例行单纯弹簧圈栓塞1例，支架辅助弹簧圈栓塞7例，开颅夹闭术1例，行枕动脉-PICA血管吻合术1例，保守治疗1例；过渡段5例，行单纯弹簧圈栓塞2例，开颅夹闭术2例，开颅动脉瘤包裹术1例；远侧段5例，行弹簧圈闭塞载瘤动脉1例，NBCA闭塞载瘤动脉1例，Gluba胶闭塞载瘤动脉1例，开颅切除动脉瘤2例。结果术后1周内死亡5例，其余病例随访6-36个月，其中近侧段行单纯弹簧圈栓塞的1例复发，再次行支架辅助弹簧圈栓塞，再随访24个月未见复发；远侧段开颅切除动脉瘤的1例术后出现共济失调，近侧段保守治疗的1例未见动脉瘤增大，其余13例未见复发及明显并发症。结论确保PICA延髓支通畅是治疗PICA动脉瘤的首要前提，PICA动脉瘤的形态、位置、PICA是否为优势血管是动脉瘤治疗方法选择的主要依据，而血管内治疗与手术相辅相成是治疗PICA动脉瘤的有效途径。Objective To explore the methods to treat posterior inferior cerebellar artery （PICA） aneurysms and their effects. Methods The clinical data of 21 patients with PICA aneurysms, of whom, 7 were treated by surgery, 13 by the endovascular embolization and 1 by conservative treatment from January, 2008 to December, 2013, were analyzed retrospectively. Results Five patients receiving the endovascular treatment died within 7 days after the embolization. Sixteen patients were followed up from 6 to 36 months. One patient receiving coils embolization was treated by stent-assisted coils embolization because the aneurysm recurred 1 year after the coils embolization. One patient undergoing the surgery still had ataxia during the following up. The aneurysm was unchanged 2 years after the conservative treatment in 1 patient. There were no recurrence of the aneurysms and complications in the other 13 patients during the following up. Conclusions The patency of the medullar branch of PICA is a prerequisite for treatment of PICA aneurysms. The method to treat PICA aneurysms should be selected according to the aneurysms and whether PICA is a superior blood vessel or not. The effects of the endovascular embolization and surgery on PICA aneurysms are good if the method to treat them is proper for PICA aneurysms.

关 键 词：小脑后下动脉动脉瘤 血管内治疗 手术 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]