开颅动脉瘤夹闭术治疗介入困难的小脑后下动脉动脉瘤

目的探讨开颅动脉瘤夹闭术治疗介入困难的破裂小脑后下动脉动脉瘤(PICA)的临床疗效。方法回顾性分析2010年9月至2013年4月应用开颅动脉瘤夹闭术治疗6例曾行血管内介入治疗失败的破裂PICA患者的临床资料。结果所有病例术前常规行骨窗位头颅血管成像(CTA)及全脑数字减影血管造影(DSA),明确动脉瘤大小、形态、瘤顶指向、位置,以及与周围组织结构关系,制定最佳手术入路。2例PICA延髓前段及1例延髓侧段动脉瘤采用枕下远外侧入路,1例延髓侧段PICA动脉瘤采用枕下乙状窦后入路,2例PICA扁桃体段动脉瘤采用枕下后正中入路。随访时间为3~28个月,平均10.5个月。所有患者恢复良好,无任何神经功能缺损,格拉斯哥预后评分(GOS)均为5分。CTA或DSA复查示6例PICA动脉瘤夹闭术后均无残留或复发。结论开颅动脉瘤夹闭术是破裂PICA动脉瘤难以实施血管内治疗时的一种安全、可靠的治疗方法,术前骨窗位CTA有助于制定最佳手术入路。

Treatment of Interventionally Difficult Posterior Inferior Cerebellar Artery Aneurysms by Surgical Clipping

Aim To identify the clinical outcome of patients with interventionally difficult ruptured posterior inferior cerebellar artery （PICA） aneurysms treated by surgical clipping. Methods Clinical data of 6 cases with interventionally difficult ruptured vertebral artery-posterior inferior cerebellar artery aneurysms treated by surgical clipping were reviewed and analyzed retrospectively from September, 2010 to April, 2013. Results Computed tomography angiography （CTA） with bone window and digital subtraction angiography （DSA） were performed before operation routinely in all eases to evaluate the size, shape, direction and relationship with peripheral structure and make an optimal surgical approach. 2 cases with anterior medullar and one case with lateral medullar segment of PICA aneurysms were treated via suboccipital far lateral approach. One case with lateral medullar segment of PICA aneurysm was via suboccipital retrosigmoid approach and 2 cases with tonsil medullar segment of PICA aneurysms were via suboccipital midline. Follow-up period ranged from 3 to28 months, averaged 10.5 months. All the patients made good recovery and presented with no neurologic deficit with Glasgow Outcome Scale （GOS） of 5 points. Follow up CTA or DSA angiogram of the 6 cases showed no recurrence or residual of the clipped aneurysm. Conclusion Surgical clipping is a safe and efficient treatment modality for patients with interventionally difficult ruptured PICA aneurysm and CTA with bone window provided significant information for preoperative planning of surgical approach.