大脑后动脉动脉瘤的临床特征和血管内治疗（附17例报告）

Clinical features and endovascniar therapy of posterior cerebral artery aneurysms： a report of 17 cases

目的探讨大脑后动脉动脉瘤的临床特征、血管内栓塞治疗方法及其效果。方法回顾性分析2009年1月至2015年3月华中科技大学同济医学院附属同济医院神经外科行血管内栓塞治疗的17例大脑后动脉动脉瘤患者的临床特点、治疗方法及其预后。17例患者共计18个动脉瘤，其中囊状动脉瘤11个（61％），梭形或夹层动脉瘤7个（39％）。动脉瘤位于大脑后动脉P1段4个，P1与P2交界区1个，P2段9个，P3段及以远段4个。8个动脉瘤行单纯弹簧圈囊内栓塞，保留载瘤动脉；6个动脉瘤行弹簧圈栓塞，同时闭塞载瘤动脉；1个动脉瘤行单纯支架置入，1个动脉瘤行球囊辅助栓塞，2个动脉瘤未予处理。采用改良Rankin量表评分（mRS）评估患者的预后。随访时间为1-5年。结果18个动脉瘤中，予以处理的15个动脉瘤术后即刻造影显示栓塞完全。1例术后出现颅内再出血后遗留神经功能障碍。17例患者中，16例获得随访，1例失随访。予以处理的动脉瘤随访期内均未见动脉瘤复发。16例患者中，改良Ptankin量表评分为0分12例，1分2例，3分2例。结论大脑后动脉动脉瘤多位于P2段，夹层或梭形动脉瘤较其他类型更为常见。根据动脉瘤的特点选择合适的血管内栓塞治疗方案，其治疗过程安全可靠，可获得满意疗效。

Objective To investigate the clinical features, endovascular embolization therapy, and treatment outcome of posterior cerebral artery aneurysms. Methods The clinical features, treatment and prognosis of 17 patients with posterior cerebral artery aneurysms embolized endovascularly at the Department of Neurosurgery, Tongji Hospital,Tongji Medical College, Huazhong University of Science and Technology from January 2009 to March 2015 were analyzed retrospectively. A total of 18 aneurysms were in 17 cases, 11 （61%） of them were saccular aneurysms, 7 （39%） were fusiform or dissecting aneurysms. Four aneurysms were located in the posterior cerebral artery P1 segment, 1 in P1 and P2 junction zone, 9 in P2 segment, and 4 in P3 segment and beyond. Eight aneurysms were treated with intracapsular coil embolization only, retaining the parent arteries, 6 aneurysms were treated with coil embolization and the parent arteries were occluded at the same time, 1 aneurysm was implanted stents, 1 aneurysm was treated with ballon-assisted embolization, and 2 were not treated. The modified Rankin scale（mRS） was used to evaluate the prognosis. The follow up time ranged from 1 to 5 years. Results In the 18 aneurysms, immediate angiography after aneurysm surgery showed that the treated 15 aneurysms were totally embolized. No cerebral ischemia occun：ed in 6 patients treated with parent artery embolization. One patient with cerebral arteriovenous malformation occurred rebleeding after procedure and left neurological dysfunction after symptomatic treatment, other patients did not have intervention-related complications and the symptom of neurological deficit. In 17 patients with posterior cerebral artery aneurysms, 16 patients completed follow-up and 1 patient lost to follow up. No recurrence in the 14 treated aneurysms have been demonstrated in the DSA reviews during the follow-up period. The mRS 0 was in 12 cases,1 in 2 cases,2 in 3 cases. Conclusions The posterior cerebral artery aneurysms are often located in P2 segments. Dissecting or fusiform aneurysms are more common than other types. According to the characteristics of aneurysms, the appropriate endovascular embolization scheme can be selected. The treatment process is safe and reliable, and the satisfactory efficacy can be obtained.