血管内治疗小脑后下动脉远端动脉瘤

Endovascular treatment for distal posterior inferior cerebellar artery aneurysms

目的探讨血管内治疗小脑后下动脉（PICA）远端动脉瘤的安全性和疗效。 方法回顾性纳入四川大学华西医院神经外科2008年1月至2015年6月收治的PICA远端动脉瘤患者，共42例，其中38例为破裂动脉瘤患者，入院时Hunt-Hess分级Ⅰ～Ⅲ级；窄颈囊状动脉瘤28例，宽颈囊状动脉瘤6例，梭形动脉瘤8例。37例采用单纯弹簧圈栓塞动脉瘤，5例采用Onyx胶闭塞载瘤动脉。 结果42例患者均成功治疗。37例单纯弹簧圈栓塞的患者中，31例（83.8%）为致密栓塞，6例（16.2%）为部分栓塞。1例术后2 d再次出血后死亡；3例术后出现吞咽困难，6个月均恢复正常。1例采用Onyx胶闭塞远端主干者出现无症状局部性延髓梗死。28例行影像学随访，随访时间为3～15个月（中位时间8.2个月），3例（7.1%）患者动脉瘤复发。 结论血管内治疗PICA远端动脉瘤安全、有效。

ObjectiveTo investigate the safety and efficacy of endovascular treatment of distal inferior cerebellar artery （PICA） aneurysms. MethodsThis retrospective study included 42 cases of distal PICA aneurysms admitted to Department of Neurosurgery, West China Hospital of Sichuan University from January 2008 to June 2015. Among those, 38 cases had ruptured aneurysms and were graded I-III at admission based on the Hunt-Hess classification. Narrow-necked saccular aneurysms were reported in 28 cases, wide-neck saccular aneurysms in 6 and fusiform aneurysms in 8 cases. In 37 cases, aneurysms were treated with coiling and 5 cases were occluded with Onyx. ResultsAll 42 patients were successfully treated. Among the 37 patients with coil embolization, 31 （83.8%） had complete embolization and 6 （16.2%） had subtotal embolization. One patient died of rebleeding 2 days after surgery. Three patients had dysphagia after surgery and recovered at 6 months. In 1 case, asymptomatic localized medullar infarction occurred with obstruction of the distal trunk by Onyx. Follow-up imaging was performed in 28 patients and lasted for 3-15 months （median duration： 8.2 months）. Aneurysms recurred in 3 （7.1%） patients. ConclusionEndovascular treatment seems an effective and safe way for distal PICA aneurysms.