椎基底动脉分支远端动脉瘤的治疗方法探讨

Discussion on the treatment methods of distal aneurysms of the vertebral-basilar arterial branches

目的：探讨椎基底动脉分支远端动脉瘤的治疗方法与策略。方法33例患者经全脑血管造影术证实为椎基底动脉分支大脑后动脉、小脑上动脉、小脑前下动脉与小脑后下动脉之远端动脉瘤，分别为8例、6例、9例、10例。其中血管内栓塞治疗29例，直接行开颅动脉瘤夹闭术2例，数字减影血管造影（DSA）与磁共振成像（MRI）三维影像融合数据输入神经导航，在神经导航指引下行开颅动脉瘤灼闭手术1例，1例因血管内栓塞治疗失败未进行手术治疗。结果所有病例无手术相关死亡，2例患者行弹簧圈栓塞术，术后1 d 患者再出血死亡，1例栓塞未成功又未行手术患者病情好转出院，余30例患者未发生术后再出血。结论椎基底动脉分支远端动脉瘤多数手术治疗难度大，应首选血管内栓塞治疗。

Objective To explore the therapy and strategy for distal aneurysms of the vertebral-basilar arterial branches.Methods A total of 33 patients underwent digital subtract angiography.Distal aneurysms of posterior cerebral artery（PCA）,superior cerebellar artery（SCA）,anterior inferior cerebellar artery（AICA）and posterior inferior cerebellar artery（PICA）were found in 8,6,9 and 1 0 cases respective-ly.There were 29 cases of endovascular embolization,2 cases of aneurysm clipping,1 case of neuronaviga-tor-assisted microsurgery guided by the three-dimensional images fusion data of DSA and MRI,and 1 failed case of endovascular embolization withoutfurther surgery.Result There were notechnique-related death in all cases.Two patientswith coil embolization died of rebleedingat the first day after operation.One patient with failed endovascular embolization did not undergo further surgery and discharged withimproved condition.There was no postoperative rebleeding in other 30 cases.Conclusion Most surgeries for distal aneurysms of the vertebral-basilar arterial branchesare difficult and endovascular embolization should be the preferred as the first choice.