破裂小脑后下动脉动脉瘤48例临床分析  

Clinical analysis of 48 cases with ruptured posterior inferior cerebellar artery aneurysms

作　　者：陈鑫 贺红卫[2] 张东[1] 张岩[1] 李佑祥[2] 赵元立[1] 曹勇[1] 王硕[1] CHEN Xin;HE Hong-Wei;ZHANG Dong;WANG Shuo(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,北京100070 [2]首都医科大学附属北京天坛医院神经介入中心,北京100070

出　　处：《临床神经外科杂志》2020年第5期481-485,共5页Journal of Clinical Neurosurgery

基　　金：国家自然科学基金面上项目(81671129);北京市东城区优秀人才项目(2018)。

摘　　要：目的探讨破裂小脑后下动脉瘤(PICA)的临床特点、治疗方式及治疗效果。方法回顾性分析48例破裂PICA患者的临床资料。其中开颅显微外科手术夹闭动脉瘤22例,血管内介入治疗23例,保守治疗3例。分析比较患者的临床表现、动脉瘤特点、治疗方式、治愈率、复发率、并发症发生率。结果开颅手术组患者的动脉瘤均完全夹闭(100%),随访无复发;术后6例患者出现手术相关并发症。介入治疗组患者中动脉瘤完全闭塞者17例(73.9%),不完全闭塞者5例,栓塞治疗失败1例;5例患者出现术后并发症,随访3例复发。保守治疗患者随访时,1例患者死亡,2例患者无变化。开颅手术组的动脉瘤完全闭塞率明显高于介入治疗组(χ^2=6.622,P=0.022);而两组并发症发生率和复发率之间的差异均无统计学意义(均P>0.05)。结论破裂PICA临床少见,开颅手术夹闭和介入治疗是其主要的治疗方式;两种治疗方式均能获得较好的疗效,而开颅手术夹闭具有更高的治愈率。Objective To summarize the clinical data of 48 cases of ruptured posterior inferior cerebellar artery(PICA)aneurysms and compare the treatment modality of surgical clipping versus endovascular treatment(EVT).Methods The clinical data of 48 ruptured PICA aneurysms were analyzed and the outcomes were compared between the craniotomy group and the EVT group.Results Aneurysms in the craniotomy group were completely clipped(100%),and no recurrence was found during follow-up.17 cases of aneurysms in interventional therapy group(73.9%)were completely embolize,and 3 relapsed during follow-up.This series of ruptured PICA aneurysms showed superiority of surgical clipping over EVT(χ^2=6.622,P=0.022)at whole elimination.However,there was no statistic differences in terms of complication(χ^2=0.186,P=0.666),recrudesce(χ^2=3.075,P=0.233),and mortality(χ^2=1.198,P=0.346).Conclusions Both surgical clipping and EVT are effective therapeutic strategies.Surgical clipping demonstrates better effectiveness than EVT in eliminating the PICA aneurysm.

关 键 词：破裂小脑后下动脉瘤 开颅夹闭手术 介入治疗 

分 类 号：R739.41[医药卫生—肿瘤]