血管内治疗小脑后下动脉动脉瘤

Endovascular treatment of posterior inferior cerebellar artery aneurysms

目的 探讨血管内治疗小脑后下动脉（PICA）动脉瘤的策略与安全性.方法 回顾性分析解放军第455医院神经外科和第二军医大学长海医院神经外科2006年5月至2014年12月共同收治的23例PICA动脉瘤患者的临床特征、血管内治疗的方法与治疗结果.14例近段动脉瘤中,3例采用支架辅助弹簧圈栓塞,9例采用单纯弹簧圈栓塞,2例不规则形夹层动脉瘤采用弹簧圈加Glubran胶闭塞载瘤动脉法.位于远段的9例动脉瘤均采用弹簧圈或Onyx胶闭塞载瘤动脉.结果 23例患者无手术操作相关并发症,近段14例患者中,12例采用保留载瘤动脉法的患者术后无新发神经功能障碍,2例闭塞载瘤动脉治疗中有1例术后出现面神经麻痹,并发症率为50％.远段的9例动脉瘤患者术后恢复良好.平均随访13个月,动脉瘤无复发.结论 血管内治疗PICA动脉瘤安全有效,治疗方法的选择与动脉瘤所在的部位有关,近段动脉瘤应尽量选择保留载瘤动脉的方法.

Objective To investigate the strategies and security of endovascular treatment of posterior inferior cerebellar artery （PICA） aneurysms.Methods The clinical characteristics,endovascular treatment methods,and treatment outcomes of 23 patients with PICA treated at the department of Neurosurgeries,the 455th Hospital of PLA and Changhai Hospital,the Second Military University from May 2006 to December 2014 were analyzed retrospectively.In 14 patients with proximal aneurysm,3 were treated with stent-assisted coil embolization,9 were embolized with coils alone,and 2 patients with irregular dissecting aneurysms were treated with coils plus Glubran glue to occlude the parent arteries.The parent arteries of 9 patients with distal aneurysm were occluded with coils or Onyx glue.Results Twenty-three patients did not have any operationrelated complications.In 14 patients with proximal aneurysm,12 did not have new neurological dysfunctions after procedure using the method of retaining parent arteries,and 1 had facial numbness and facial paralysis after procedure in the occlusion of the parent arteries in 2 cases.The incidence of complications was 50%.Nine patients with distal aneurysm recovered well after procedure.They were followed up for 13 months.No recurrence of aneurysms was observed.Conclusions Endovascular treatment of PICA aneurysms is safe and effective.The choice of treatment methods is associated with the location of aneurysms.For proximal aneurysms,we should try to choose the method of retaining parent arteries.