显微手术治疗小脑后下动脉瘤的临床分析

Clinical analysis of posterior inferior cerebellar aneurysms treated with microsurgery

目的 探讨小脑后下动脉瘤的影像学特征及外科治疗方案。方法 回顾性分析 5例小脑后下动脉瘤的临床特点、影像学特征及手术治疗效果。结果 5例中有 4例因动脉瘤破裂出血而发病 ,CT检查均有第Ⅳ脑室出血 ;1例首发症状为步态不稳及后组颅神经不全性麻痹 ,经CT检查为后颅窝占位性病变。DSA检查可显示动脉瘤的具体部位及大小。 5例均经后颅窝开颅显微手术治疗 ,其中动脉瘤蒂夹闭 3例 ,行动脉瘤加固术及孤立术各 1例。 5例中除 1例术后留有轻度偏瘫外 ,余 4例恢复良好。结论 小脑后下动脉瘤多以第Ⅳ脑室出血发病 ,少数可以小脑及后组颅神经损害为首发症状 ,及早诊断和治疗 ,疗效是满意的。手术方式应尽量夹闭动脉瘤蒂 ,对夹层动脉瘤可采用加固术 。

Objective To explore imaging character and microsurgical treatment of posterior inferior cerebellar aneurysms.Methods Retrospective analysis of clinical and imaging character and the results of microsurgical treatment in 5 cases of posterior inferior cerebellar aneurysms.Results Four cases of rupture of aneurysms and CT findings revealed the fourth ventricular hemorrhage:one case experienced running disorder and incomplete paralysis of cranial nerve and CT scan confirmed massive lesion in posterior fossa.DSA examination may reveal the size and position of aneurysms.All 5 patients were treated by microsurgical operation.Among them three received aneurysmal clip,one had wrapping,and the remining one underwent prosical occlusion of posterior interior cerebellar artery.Four cases had good results and one case had slight hemiplegia.Conclusion Most of posterior inferior cerebellar aneurysms are complicated with the fourth ventricular hemorrhage and a few occurred with damage of cerebellar function and later groups of cranial nerves.The outcome is good by earlier diagnosis and operation.The wrapping is usually used in patients with dissecting aneurysms and the proximal occlusion of posterior inferior cerebellar atrtery is used in patients in whom clipping is countraindicated.