小脑动脉远端动脉瘤的介入治疗

Endovascular treatment for distal cerebellar artery aneurysms

目的总结小脑动脉远端动脉瘤的临床和影像学特征,探讨血管内介入治疗方法的安全性及有效性。方法回顾性分析8例小脑动脉远端动脉瘤病人的临床资料,动脉瘤位于小脑上动脉（SCA）2例,小脑前下动脉（AICA）3例,小脑后下动脉（PICA）3例;其中伴小脑动静脉畸形（AVM）4例。单纯弹簧圈栓塞动脉瘤3例,弹簧圈同时闭塞动脉瘤及载瘤动脉5例;生物胶栓塞AVM 3例,伽玛刀治疗AVM 1例。结果动脉瘤均达到完全栓塞,术后出现小脑梗死2例。出院时改良Rankin评分：0分2例,1分5例,2分1例。随访2~40个月,均无动脉瘤再次出血、复发及死亡病例。结论小脑动脉远端动脉瘤血管内介入治疗安全可行,能有效预防短、中期再出血,但需定期血管造影随访以防止复发。

Objective To summarize the clinical and imaging characteristics of distal cerebellar artery aneurysms, and explore the safety and effectiveness of endovascular treatment. Methods Clinical data of 8 patients with distal cerebellar artery aneurysm（CAA）were analyzed retrospectively, including 2 superior CAAs, 3 anterior inferior CAAs and 3 posterior inferior CAAs, and 4 patients with cerebellar arteriovenous malformation（AVM）. Coil embolization alone for aneurysms was performed in 3 patients, and the aneurysms and parent arteries were occluded simultaneously in 5. Three patients with AVM were treated with Biogel and 1 patient with Gamma knife. Results Complete embolization was achieved in all of the aneurysms, and postoperative cerebellar infarction occurred in 2patients. Modified Rankin scores at discharge were 0 in 2 patients, 1 in 5 and 2 in 1 patient. During a follow-up period of 2 to 40 months, all the patients had no rebleeding and recurrence, and no patient died. Conclusion Endovascular treatment is feasible and safe for distal CAAs, and can effectively prevent the rebleeding in short and medium term, however, regular angiographic follow-up is necessary to prevent recurrence.