载瘤动脉闭塞治疗小脑后下动脉以远椎动脉瘤二例报告并文献复习

Treatment of vertebral aneurysms distal to the origin of posterior inferior cerebellar artery by occluding the parent artery： a report of 2 cases and literature review

目的探讨载瘤动脉闭塞治疗小脑后下动脉（PICA）122远椎动脉瘤的方法和效果。方法中山大学附属佛山第一人民医院神经外科自2006年1月至2007年1月对2例PICA以远椎动脉瘤破裂患者行介入载瘤动脉电解可脱弹簧圈（GDC）闭塞治疗，分析患者的临床特征、影像学特点和栓塞疗效。结果2例患者术后PICA以远载瘤动脉合并动脉瘤均成功获得完全闭塞。无术后并发症发生。术后3个月造影复查证实动脉瘤体无充盈，同时PICA通畅，4年内无再出血发生。结论对于开颅手术夹必困难的PICA以远椎动脉瘤，在PICA远端处闭塞一侧载瘤椎动脉是一种安全、有效的治疗方法。

Objective To summarize the clinical characteristics, therapeutic strategy and outcome of the vertebral aneurysms distal to the origin of posterior inferior cerebellar artery （PICA）. Methods Two patients with vertebral posterior aneurysms distal to the origin of PICA, admitted to our hospital from January 2006 to January 2007 and received endovascular treatment of Gugliemi detachable coils （GDC）, were submitted to a retrospective analysis of clinical features, radiological characteristics and therapeutic effects. Results Total occlusion was achieved in these 2 patients and no immediate complication occurred after the treatment. They were followed up for 3 months to 4 years; the postoperative digital subtraction angiography （DSA） revealed that the PICA was unobstructed and no rehaemorrhagia was noted. Conclusion Endovascular therapy with microcoil placement may be a safe and available alternative for the treatment of some complicated aneurysms of vertebral artery aneurysms distal to the origin of PICA, which is difficult to be clipped.