不同手术方式治疗小脑后下动脉动脉瘤的临床疗效

目的探讨不同手术方式治疗小脑后下动脉动脉瘤的临床疗效。方法回顾性分析2014年10月至2017年5月威海市中心医院神经外科收治的36例小脑后下动脉动脉瘤患者(共36个动脉瘤)的临床资料。36例患者中,行单纯介入栓塞22例,行单纯开颅手术夹闭9例,5例行开颅血管搭桥联合介入栓塞手术。以出院时格拉斯哥预后评级(GOS)评估手术治疗效果,采用改良Rankin量表评分(mRS)评估患者的临床结局。通过数字减影血管造影(DSA)或CT血管成像(CTA)评估影像学结局。结果行单纯介入栓塞的22例患者中,完全栓塞21例;行单纯开颅手术夹闭的9例患者中,成功夹闭8例;5例应用开颅血管搭桥联合介入栓塞的患者均成功吻合血管并达到完全栓塞。36例患者中,9例术后存在非新发的神经功能缺失,1例术后死亡。35例患者出院时的GOS为:Ⅴ级18例,Ⅳ级14例,Ⅲ级3例。35例患者术后2周复查CTA或DSA,显示动脉瘤均消失。术后3~12个月的影像学随访结果显示,动脉瘤复发3例(8.6%),均为行介入栓塞的患者;其余32例未见动脉瘤复发。34例获临床随访1年,mRS 0~1分21例,2分8例,3分3例,4分1例,5分1例,预后良好率为85.3%(29/34);失访1例。结论根据具体病情采用介入栓塞术、开颅夹闭术或开颅血管搭桥联合介入栓塞治疗小脑后下动脉动脉瘤,患者的临床预后较好,动脉瘤复发率低。

Effect of different surgical options for posterior inferior cerebellar artery aneurysms

Objective To explore the clinical effect of various surgical operations on the treatment of posterior inferior cerebellar aneurysm.Methods The clinical data of 36 patients with a total of 36 posterior inferior cerebellar aneurysms admitted to Department of Neurosurgery,Weihai Central Hospital from October 2014 to May 2017 were retrospectively analyzed.Among all 36 patients,22 underwent transcatheter embolization,9 underwent aneurysm clipping using craniotomy,and the remaining 5 underwent cerebral artery bypass surgery combined with transcatheter embolization.The treatment outcome was evaluated using Glasgow outcome scale(GOS)at discharge and modified Rankin scale(mRS)at follow-up.Imaging outcome was evaluated by digital subtraction angiography(DSA)or CT angiography(CTA).Results Of the 22 patients undergoing transcatheter embolization,21 were completely embolized.Aneurysms in 8 of the 9 patients were successfully clipped.Successful vascular anastomosis and complete embolization were achieved in 5 patients undergoing cerebral artery bypass surgery combined with transcatheter embolization.Among the 36 patients,9 cases developed non-newly developed postoperative neurological deficits and 1 died.Thirty-five patients were discharged with GOS gradeⅤin 18 cases,Ⅳin 14 cases andⅢin 3 cases.Thirty-five cases were reexamined by CTA or DSA at 2 weeks post operation,which indicated disappearance of aneurysm.At follow-up of 3 months to 1 year post operation,3 cases(8.6%)of aneurysm recurrence were reported which had undergone interventional embolization,and the rest of 32 patients had no recurrence.Thirty-five patients were followed up for 1 year.The mRS score was 0-1 in 21 cases,2 in 8,3 in 3,4 in 1 and 5 in 1 case.The rate of good outcome were 85.3%(29/34)and there was 1 patient lost to follow-up.Conclusions According to the specific condition,interventional embolization,craniotomy of aneurysm clipping,or cerebral artery bypass surgery combined with transcatheter embolization could be performed to treat the posterior inferior cerebellar aneurysm,which might lead to relatively good clinical outcome with low incidence of aneurysm recurrence.