小脑后下动脉动脉瘤的血管内治疗与手术治疗(附21例报道)

Endovascular embolization and microsurgery of posterior inferior cerebellar artery aneurysms(report of 21 cases)

目的：探讨小脑后下动脉（PICA）动脉瘤的血管内治疗与手术治疗效果。方法回顾性分析21例PICA动脉瘤患者的临床资料，其中近侧段11例行单纯弹簧圈栓塞1例，支架辅助弹簧圈栓塞7例，开颅夹闭术1例，行枕动脉-PICA血管吻合术1例，保守治疗1例；过渡段5例，行单纯弹簧圈栓塞2例，开颅夹闭术2例，开颅动脉瘤包裹术1例；远侧段5例，行弹簧圈闭塞载瘤动脉1例，NBCA闭塞载瘤动脉1例，Gluba胶闭塞载瘤动脉1例，开颅切除动脉瘤2例。结果术后1周内死亡5例，其余病例随访6-36个月，其中近侧段行单纯弹簧圈栓塞的1例复发，再次行支架辅助弹簧圈栓塞，再随访24个月未见复发；远侧段开颅切除动脉瘤的1例术后出现共济失调，近侧段保守治疗的1例未见动脉瘤增大，其余13例未见复发及明显并发症。结论确保PICA延髓支通畅是治疗PICA动脉瘤的首要前提，PICA动脉瘤的形态、位置、PICA是否为优势血管是动脉瘤治疗方法选择的主要依据，而血管内治疗与手术相辅相成是治疗PICA动脉瘤的有效途径。

Objective To explore the methods to treat posterior inferior cerebellar artery （PICA） aneurysms and their effects. Methods The clinical data of 21 patients with PICA aneurysms, of whom, 7 were treated by surgery, 13 by the endovascular embolization and 1 by conservative treatment from January, 2008 to December, 2013, were analyzed retrospectively. Results Five patients receiving the endovascular treatment died within 7 days after the embolization. Sixteen patients were followed up from 6 to 36 months. One patient receiving coils embolization was treated by stent-assisted coils embolization because the aneurysm recurred 1 year after the coils embolization. One patient undergoing the surgery still had ataxia during the following up. The aneurysm was unchanged 2 years after the conservative treatment in 1 patient. There were no recurrence of the aneurysms and complications in the other 13 patients during the following up. Conclusions The patency of the medullar branch of PICA is a prerequisite for treatment of PICA aneurysms. The method to treat PICA aneurysms should be selected according to the aneurysms and whether PICA is a superior blood vessel or not. The effects of the endovascular embolization and surgery on PICA aneurysms are good if the method to treat them is proper for PICA aneurysms.