Microsurgical treatment of posterior inferior cerebellar aneurysms based on angioarchitecture supplemented by high-resolution vessel wall MRI:a case series report  

作　　者：Zixiao Yang Jianping Song Kai Quan Peiliang Li Qingzhu An Yuan Shi Peixi Liu Guo Yu Yanlong Tian Liangfu Zhou Wei Zhu 

机构地区：[1]Department of Neurosurgery,Huashan Hospital Fudan University,Shanghai,China [2]National Center for Neurological Disorders,Shanghai,China [3]Neurosurgical Institute of Fudan University,Shanghai,China [4]Shanghai Clinical Medical Center of Neurosurgery,Shanghai,China

出　　处：《Stroke & Vascular Neurology》2022年第4期337-344,I0046-I0050,共13页卒中与血管神经病学（英文）

基　　金：supported by the Outstanding Academic Leaders Program of Shanghai Municipal Commission of Health and Family Planning(No.2017BR006 to WZ);the Shanghai Rising-Star Program(No.18QA1400900 to JS.);Shanghai Sailing Promgram(No.22YF1404500 to ZY).

摘　　要：Background Surgical treatment of posterior inferior cerebellar artery(PICA)aneurysms is challenging because many are nonsaccular and atherosclerotic.We report our tailored approach to PICA aneurysms,which is based on angioarchitecture supplemented by high-resolution vessel wall MRI(HR-VW MRI)findings.Methods From March 2010 to September 2020,27 patients with 29 PICA aneurysms underwent surgical treatment in our institution.Since October 2016,HR-VW MRI has been used for aneurysmal wall assessment.Clinical characteristics,radiological data and surgical outcomes were analysed.Results Nineteen proximal PICA aneurysms(vertebral artery(VA),P1,P2 and P3)were treated using the far-lateral approach.Ten distal PICA aneurysms(P4,P5)were treated using the suboccipital midline approach.Direct clipping or clip reconstruction was achieved in 19 aneurysms.Ten were trapped in conjunction with extracranial-intracranial or intracranial-intracranial bypass,including three occipital artery-PICA reimplantations,three PICA-VA reimplantations,two PICA-PICA side-to side anastomoses,one PICA-PICA reimplantation and one PICA-PICA reanastomosis.All aneurysms were eventually completely obliterated and all bypasses remained patent.At the last follow-up,26 patients(96.2%)achieved a good outcome(modified Rankin Scale score<3).Eight patients underwent HR-VW MRI.Among these,the six aneurysms with focal wall enhancement required bypass and the two with negative enhancement were successfully clipped.Conclusion PICA aneurysms have a higher frequency of complex features such as large or giant size and fusiform or dissecting morphology.Favourable outcomes were achieved with individualised microsurgical strategies based on angioarchitecture.HR-VW MRI may be used as a promising technique to predict aneurysmal atherosclerosis.

关 键 词：ANEURYSM treatment implantation 

分 类 号：R732.21[医药卫生—肿瘤]