脑血管重建术治疗小脑后下动脉起始部异常吻合并发动脉瘤两例并文献复习

Cerebral vascular reconstruction in the treatment of abnormal anastomosis of origin posterior inferior cerebellar artery complicated with aneurysms:two cases reports and literature review

目的总结2例小脑后下动脉起始部异常吻合并发动脉瘤的临床特点和治疗方案。方法与结果 2例小脑后下动脉起始部异常吻合并发动脉瘤患者均表现为自发性蛛网膜下腔出血,MRI表现为小脑后下动脉起始部异常吻合,伴吻合血管或吻合部位多发微小动脉瘤,均行枕动脉-小脑后下动脉(OA-PICA)搭桥术并同期电凝动脉瘤。以"PICA anastomosis"等作为关键词检索美国国立医学图书馆生物医学文献数据库(PubMed,2000年1月1日至2021年6月30日),共获得英文文献8篇计8例患者,结合本文2例病例,共计10例小脑后下动脉起始部异常吻合并发动脉瘤患者。均以自发性蛛网膜下腔出血发病;8例动脉瘤发生于吻合部位,1例发生于小脑后下动脉远端,1例发生于起源动脉的一支。5例行开颅手术,分别为OA-PICA搭桥术3例并同期电凝(2例)或夹闭(1例)动脉瘤,单纯动脉瘤夹闭术1例,动脉瘤夹闭合并切断吻合动脉1例,术后均无明确并发症;4例行血管内介入治疗,分别为弹簧圈栓塞动脉瘤2例,Glubran胶栓塞动脉瘤2例,其中3例出现术后并发症,表现为轻微脑干梗死(2例)或意识障碍(1例)。结论小脑后下动脉起始部异常吻合并发动脉瘤罕见,破裂出血风险高,可选择OA-PICA搭桥术并电凝或夹闭动脉瘤的方式。

Objective Summarize the clinical characteristics and treatment plan of 2 cases of abnormal anastomosis at the origin of the posterior inferior cerebellar artery(PICA) complicated with aneurysm.Methods and Results Two cases of abnormal anastomosis of the PICA complicated with aneurysms all showed spontaneous subarachnoid hemorrhage(SAH).MRI showed abnormal anastomosis of the PICA,accompanied by multiple small aneurysms at the anastomotic vessel or anastomotic site.All patients underwent occipital artery(OA)-PICA bypass graft and electrocoagulation of the aneurysms at the same time.Use "PICA anastomosis" as the key words to search PubMed(January 1,2000 to June 30,2021) 8 articles in English,8 patients,combined with 2 cases in this article cases,a total of 10 patients with abnormal anastomosis at the origin of the PICA complicated with aneurysm.All cases occurred as spontaneous SAH;8 cases of aneurysms occurred at the anastomosis site,one case occurred at the distal end of the PICA,and one case occurred in a branch of the original artery.Five cases underwent craniotomy,3 cases of OA-PICA bypass surgery and concurrent electrocoagulation(2 cases) or clipping(one case) of the aneurysms,one case of simple aneurysm clipping,and one case of aneurysm clipping combined with cutting off anastomotic artery,and there were no clear complications after surgery;4 cases underwent endovascular interventional treatment,2 cases of coil embolization of aneurysms,2 cases of Glubran glue embolization of aneurysms,of which 3 cases had postoperative complications,manifested as mild brainstem infarction(2 cases) or disturbance of consciousness(one case).Conclusions Abnormal anastomosis at the origin of the PICA complicated with aneurysm is rare,and the risk of rupture and hemorrhage is high.OAPICA bypass and electrocoagulation or clipping of the aneurysm can be used as a treatment option.