小脑后下动脉动脉瘤的分型与栓塞策略

【作者】 赵兵； 钟鸣； 谭显西； 郑匡； 何文根； 李连进；

【机构】 温州医学院附属第一医院神经外科；

【摘要】 目的探讨小脑后下动脉(PICA)动脉瘤的分型与栓塞策略。方法回顾性分析21例PICA动脉瘤经血管内栓塞治疗临床资料,根据椎动脉侧位DSA图像进行分类,PICA开口到尾袢为袢前段,尾袢到头袢为袢中段,头袢到小脑皮层支为袢后段;根据动脉瘤的形态分为,Ⅰ型囊性动脉瘤,Ⅱ型非囊性动脉瘤或合并血管畸形。袢前段Ⅰ型5例,Ⅱ型4例;袢中段Ⅰ型4例,Ⅱ型1例;袢后段Ⅰ型5例,Ⅱ型2例。结果1.8例行单纯弹簧圈栓塞治疗,5例单纯液体胶栓塞治疗,2例弹簧圈联合液体胶栓塞治疗,2例支架辅助弹簧圈栓塞,4例PICA动脉闭塞;11例动脉瘤100%闭塞、5例90%以上闭塞,1例85%栓塞,4例载瘤动脉并动脉瘤闭塞;2.治疗效果:术后死亡1例,新发神经功能症状1例,电话随访4月-5年,无术后再出血,无明显小脑损害症状,4个月后GOS评分1级1例,2级1例,3级2例,4级5例,5级12例。结论PICA实时造影分型有利于栓塞方法的选择和风险评估。更多还原

【Abstract】 Objective To study the classification and endovascular treatment of posterior inferior cerebellar artery aneurysms. Methods The clinical manifestation,the character of imaging and the results of endovascular treatment in 21 cases of posterior inferior cerebellar(PICA) aneurysms.According to the vertebral artery DSA lateral position images,these aneurysm of PICA were classified into there types,anterior loop,middle loop and lateral loop; According to forms of aneurysms,these aneurysm were classified into berry aneurysm and aneurysm of no berry or malformation.Thus all the patients with aneurysm were divided into different groups including 5 cases of anterior loop typeⅠ,4 cased of typeⅡ;4 cases of middle loop typeⅠand one case of typeⅡ;5 cases of lateral loop typeⅠand 2 typeⅡ. Results Twenty one patients were treated by the embolization,in which 8 cases of routine aneurysm coil embolization,5 cases of simple liquid Glue embolization,2 cases combined coil embolization and liquid Glue, 2 cases of stent-assisted coil embolization;4 cases of PICA Occlusion.11 cases of aneurysm occlusion 100%,5 cases of more than 90%occlusion,one case of 85%of the embolization,4 cases of the parent artery and aneurysm occlusion were observed.Finally,one case of death and one case with new neurological symptoms were found after operation.No re-bleeding and no symptoms of cerebellar damage were found in follow up from 4 months to 5years by telephone.These patients were evaluated by the GOS after 4 months.Most patients(n=12) had good outcome of 5 scores of GOS. Conclusions The classification according to the angiography of the PICA aneurysms is helpful for method of selection and risk assessment.更多还原