血流重建方法治疗复杂小脑后下动脉近端动脉瘤

Revascularization treatment for complex proximal posterior inferior cerebellar artery aneurysms

目的探讨应用血流重建方法治疗复杂小脑后下动脉近端动脉瘤的临床疗效。方法回顾性分析2008年6月至2018年1月天津市环湖医院神经外科收治的10例(占同期小脑后下动脉动脉瘤的5.1%,10/198)复杂小脑后下动脉近端动脉瘤患者(共10个动脉瘤)的临床资料。根据动脉瘤的形态及侧支循环情况选择不同的血流重建方式,其中行枕动脉-小脑后下动脉吻合术+动脉瘤孤立术8例,枕动脉-小脑后下动脉吻合术+椎动脉闭塞术1例,动脉瘤减压+小脑后下动脉原位吻合1例。术后观察吻合血管的通畅情况以及并发症的发生情况,采用改良Rankin量表评分(mRS)评估患者的预后。结果10例患者均顺利完成血流重建,术中荧光造影显示吻合血管通畅。其中2例术后出现声音嘶哑,经治疗后恢复正常,1例术后3 d出现呼吸困难、肺部感染,经治疗后恢复正常。10例患者术后随访3~118个月,中位随访时间为17.5个月。随访期间未见动脉瘤复发或破裂出血,1例患者术后12个月死于高血压性脑出血,1例因脑积水行脑室-腹腔分流术。9例吻合血管通畅,1例吻合血管闭塞,10例患者的动脉瘤均消失。mRS评分0分8例,1分1例,6分1例。结论对于复杂小脑后下动脉近端动脉瘤,根据动脉瘤的形态和侧支循环代偿情况采取血流重建的治疗方法可减轻动脉瘤的占位效应或完全去除动脉瘤。

Objective To evaluate the clinical effect of revascularization on the treatment of complex proximal posterior inferior cerebellar artery (PICA) aneurysms. Methods A retrospective analysis was conducted on 10 cases (accounting for 5.1% of 10/198 cases of PICA aneurysm admitted during the same period) of complex proximal PICA aneurysms (10 aneurysms) who were admitted to Neurosurgical Department of Tianjin Huanhu Hospital from June 2008 to January 2018. According to the morphological characteristics and collateral circulation of aneurysms, various ways of revascularization were undergone. Eight cases underwent occipital artery (OA)-PICA anastomosis + aneurysm trapping;vertebral artery (VA) occlusion + OA-PICA anastomosis was performed in 1 case;aneurysm depression and PICA in situ anastomosis was performed in 1 case. The patency of anastomotic vessels and postoperative complications were observed after operation and the patients' outcomes were evaluated with modified Rankin scale (mRS). Results Ten cases successfully underwent the blood flow reconstruction. Intraoperative fluorescein angiography revealed the patency of anastomotic vessels. Two cases developed hoarseness post operation and fully recovered to normal after treatment. One patient developed dyspnea and pulmonary infection 3 days post operation and fully recovered to normal after treatment. Ten cases were followed up effectively. The follow-up period was 3-118 months after operation. No recurrent or ruptured aneurysms were found in the follow-up period. One patient died of cerebral hemorrhage because of hypertension after 12 months. Ventriculoperitoneal drainage was performed in 1 case of hydrocephalus. Nine cases of anastomotic vessels were patent and 1 case showed occlusion. All aneurysms disappeared. The score of mRS was 0 in 8 cases, 1 in 1 and 6 in 1. Conclusions Depending on the morphological characteristics and collateral circulation, different revascularization techniques are selected. Revascularization is an effective method for the treatment of complex proximal PICA aneurysms in terms of relief of space-occupying effect and removal of aneurysms.