小脑前下动脉瘤五例报告

Anterior inferior cerebellar artery aneurysms - report of five cases

目的探讨小脑前下动脉(AICA)动脉瘤的临床特征、治疗方式的选择及操作技巧。方法回顾性分析5例AICA动脉瘤的临床资料。结果AICA远端囊性动脉瘤3例,其中2例位于内听道口,1例位于小脑绒球腹侧、面听神经背侧,并伴有同侧小脑半球小型隐匿性血管畸形,术中借助神经内镜发现动脉瘤,3例均行手术夹闭,并于术后住院期间行脑血管造影复查,夹闭满意;AICA近端囊性动脉瘤2例,均采用血管内介入治疗。患者预后优4例,良1例。结论AICA远端动脉瘤宜首选手术夹闭,术中辅助神经内镜有助于提高显微手术效果;AICA近端动脉瘤宜首选血管内介入治疗。

Objective To explore the clinical characteristics and treatment methods of anterior inferior cerebellar artery （AICA） aneurysms. Methods Clinical data of 5 AICA-aneurysms in 5 patients were analyzed retrospectively. Results Three cases of distal saccular AICA aneurysms, whose diamerter was 16mm in one and no larger than 5ram in the other two, were clipped. Two aneurysms were located near the internal auditory meatus, the other one was at the ventral surface of the flocculus cerebelli and the dorsal surface of the Ⅶ,Ⅷ cranial nerves, which had a small occult AVM at the ipsilateral cerebellar hemisphere was found in operation by neuro-endoscope. All 3 were clipped satisfactorily, as confirmed by postoperative angiogram in hospital; Two cases of proximal saccular AICA aneurysms were cured by endovascular embolization. On follow-up, four patients were excellent and one good. Conclusions The distal AICA aneurysms are suitable for surgical clip, and the microsurgical effect could be improved by using neuroendoscope; However, the proximal AICA aneurysms should be treated by endovascular embolization.