小脑后下动脉动脉瘤的血管内治疗与手术治疗（附21例报道）

目的 探讨小脑后下动脉（PICA）动脉瘤的血管内治疗与手术治疗效果。方法 回顾性分析21例PICA动脉瘤患者的临床资料，其中近侧段11例行单纯弹簧圈栓塞1例，支架辅助弹簧圈栓塞7例，开颅夹闭术1例，行枕动脉-PICA血管吻合术1例，保守治疗1例；过渡段5例，行单纯弹簧圈栓塞2例，开颅夹闭术2例，开颅动脉瘤包裹术1例；远侧段5例，行弹簧圈闭塞载瘤动脉1例，NBCA闭塞载瘤动脉1例，Gluba胶闭塞载瘤动脉1例，开颅切除动脉瘤2例。结果 术后1周内死亡5例，其余病例随访6~36个月，其中近侧段行单纯弹簧圈栓塞的1例复发，再次行支架辅助弹簧圈栓塞，再随访24个月未见复发；远侧段开颅切除动脉瘤的1例术后出现共济失调，近侧段保守治疗的1例未见动脉瘤增大，其余13例未见复发及明显并发症。结论 确保PICA延髓支通畅是治疗PICA动脉瘤的首要前提，PICA动脉瘤的形态、位置、PICA是否为优势血管是动脉瘤治疗方法选择的主要依据，而血管内治疗与手术相辅相成是治疗PICA动脉瘤的有效途径。

Endovascular embolization and microsurgery of posterior inferior cerebellar artery aneurysms (report of 21 cases)

Objective To explore the Methods to treat posterior inferior cerebellar artery (PICA) aneurysms and their effects. Methods The clinical data of 21 patients with PICA aneurysms, of whom, 7 were treated by surgery, 13 by the endovascular embolization and 1 by conservative treatment from January, 2008 to December, 2013, were analyzed retrospectively. Results Five patients receiving the endovascular treatment died within 7 days after the embolization. Sixteen patients were followed up from 6 to 36 months. One patient receiving coils embolization was treated by stent-assisted coils embolization because the aneurysm recurred 1 year after the coils embolization. One patient undergoing the surgery still had ataxia during the following up. The aneurysm was unchanged 2 years after the conservative treatment in 1 patient. There were no recurrence of the aneurysms and complications in the other 13 patients during the following up. Conclusions The patency of the medullar branch of PICA is a prerequisite for treatment of PICA aneurysms. The method to treat PICA aneurysms should be selected according to the aneurysms and whether PICA is a superior blood vessel or not. The effects of the endovascular embolization and surgery on PICA aneurysms are good if the method to treat them is proper for PICA aneurysms.