小脑后下动脉远端动脉瘤的临床特征及手术治疗

目的探讨小脑后下动脉(PICA)远端动脉瘤的临床特征、诊断及手术治疗方法。方法回顾性分析2008年1月至2010年3月收治的8例PICA远端动脉瘤的临床表现、影像学特征、手术治疗及预后情况。结果所有病例均经显微手术治疗,其中经枕下正中入路手术6例,经枕下远外侧入路手术2例。动脉瘤瘤颈夹闭6例,动脉瘤孤立切除2例;脑室出血急性期行脑室外引流3例。随访3个月至2年,三维CT血管造影复查示5例患者动脉瘤消失,2例因脑积水加重行脑室-腹腔分流术。根据GOS评分,3分1例,4分1例,5分6例。结论 PICA远端动脉瘤以第四脑室内出血或小脑蚓部出血为主要表现,部分病人合并脑积水,诊断需行脑血管造影检查,一旦确诊应尽快手术治疗,效果较好。

Clinical characteristics and surgical treatment of distal posterior inferior cerebellar artery aneurysms(a report of 8 cases)

Objective To investigate the clinical Characteristics and the surgical treatment of distal posterior inferior cerebellar artery （PICA） aneurysms. Methods The clinical data of 8 patients with distal PICA aneurysms, of whom, 6 underwent microsurgery through the median suboccipital approach and 2 through far-lateral suboccipital approach from January, 2008 to March, 2010 in our hospital, were analyzed retrospectively. The clinical data included the clinical manifestations, characteristics of imaging, surgical methods and prognoses in all the patients. The external ventricular drainage was performed during acute phase in 3 patients with intraventricular hemorrhage. Results The aneurysmal necks were successfully clipped in 6 patients and the aneurysms were isolated and resected in 2. All the patients were followed up 3 months to 2 years. No aneurysms recurred in 5 patients receiving 3D-CTA examination. The ventriculo-peritoneal shunt was performed due to hydrocephalus in 2 patients. GOS was 5 points in 6 patients, 4 in 1 and 3 in 1. Conclusions The main clinical manifestations include the hemorrhage in the fourth ventricle or cerebellar vermis and hydrocephalus. The 3D-CTA is helpful to the diagnosis of distal PICA aneurysms. Once the diagnosis is definitely made, the surgery should be performed as quickly as possible in order to improve the prognoses in the patients with distal PICA aneurysms.