小脑后下动脉远端破裂动脉瘤的临床特点和手术疗效分析  

Clinical features and surgical management of ruptured distal posterior inferior cerebellar artery aneurysms

作　　者：杨忠平[1] 杨雷方 梁磊[1] 丁新民 范益民[2] Yang Zhongping;Yang Leifang;Liang Lei;Ding Xinmin;Fan Yimin(Neurosurgery Department,the Third Afiliated Hospital of Shanxi Medical University,Shanxi Bethune Hospital(Shanxi Academy of Medical Sciences),Tongji Shanxi Hospital,Taiyuan 030032,China;Neurosurgery Department,the First Affliated Hospital of Shanxi Medical University,Taiyuan 030009,China)

机构地区：[1]山西医科大学第三医院神经外科,山西白求恩医院(山西医学科学院),同济山西医院,太原030032 [2]山西医科大学第一医院神经外科,太原030009

出　　处：《中华神经外科杂志》2024年第11期1104-1108,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨小脑后下动脉(PICA)远端破裂动脉瘤的临床特点和手术疗效。方法回顾性分析2013年1月到2023年12月山西医科大学第三医院神经外科收治的13例PICA远端动脉瘤患者的临床资料。其中11例行开颅显微手术, 2例行单纯弹簧圈栓塞术。分析患者的疾病特点及手术疗效。结果 13例患者中, 入院时Hunt-Hess分级Ⅱ级5例、Ⅲ级4例、Ⅳ级2例、Ⅴ级2例, 出血主要分布在小脑延髓池、枕大池、小脑脑桥角池等后颅窝蛛网膜下腔, 第四脑室、小脑蚓部及小脑半球。动脉瘤位于PICA延髓前段1例, 延髓外侧段4例, 延髓扁桃体段5例, 膜帆扁桃体段1例, 皮质段2例。囊状动脉瘤11例, 梭形动脉瘤2例。动脉瘤最大直径为0.3~2.5 cm。13例患者术中动脉瘤均完全闭塞, 载瘤动脉瘤通畅。11例行开颅手术的患者中, 术后发生后组脑神经一过性损伤1例;小脑半球脑梗死1例, 遗留共济失调症状;3例术后因脑积水再次行脑室-腹腔分流术, 其中1例死亡。术后6个月随访, 格拉斯哥预后评级Ⅰ级1例, Ⅲ级2例, Ⅳ级1例, Ⅴ级9例;8例影像学随访未见动脉瘤复发。结论 PICA远端动脉瘤多为囊状动脉瘤, 延髓外侧段和延髓扁桃体段多见, 脑积水发生比例高。血管内弹簧圈栓塞术和开颅显微手术均可取得较好的疗效。Objective To explore the clinical features and surgical treatment of ruptured distal posterior inferior cerebellar artery(PICA)aneurysms.Methods A retrospective study was conducted on the clinical data of 13 patients with distal PICA aneurysms who were admitted to the Neurosurgery Department of the Third Affiliated Hospital of Shanxi Medical University from January 2013 to December 2023.There were 11 patients who underwent microneurosurgical management and 2 patients who underwent simple endovascular coil embolization.The characteristics of the disease and the operative outcomes were analyzed.Results The Hunt-Hess grade was Ⅱ in 5 patients,Ⅲ in 4 patients,Ⅳ in 2 patients and Ⅴ in 2 patients at admission.The bleeding was mainly distributed in the cerebellar medullary cistern,cisterna magna,cerebellopontine angle cistern,the other subarachnoid space of posterior cranial fossa,fourth ventricle,cerebellar vermis and cerebellar hemispheres.The aneurysm was located in the anterior medullary segment in 1 case,lateral medullary segment in 4 cases,tonsillomedullary segment in 5 cases,telovelotonsillar segment in 1 case,and cortical segment in 2 cases.There were 11 saccular aneurysms and 2 fusiform aneurysms.The maximum diameter of the aneurysm was 0.3 cm to 2.5 cm.Aneurysms were completely eliminated and PICA remained patent in the operation among 13 cases.There was 1 patient who exhibited transient injury of lower cranial nerves,1 patient who exhibited the cerebral infarction with ataxia and 3 hydrocephalus patients who underwent ventriculoperitoneal shunt,one of which died.At 6-month follow-up,there were 1 case of Clasgow grade Ⅰ,2 cases of grade Ⅲ,1 case of grade Ⅳ,and 9 cases of grade V;8 cases of imaging follow-up showed no recurrence of aneurysm,and the PICA was patent.Conclusions Most of distal PICA aneurysms are saccular.PICA aneurysms are more common in the lateral medullary segment and tonsillomedullary segment.The incidence of hydrocephalus is high.Both endovascular coil embolization and craniotom

关 键 词：动脉瘤 破裂 小脑后下动脉 神经外科手术 血管内操作 疾病特征 治疗结果 

分 类 号：R651.12[医药卫生—外科学]