Dissecting Aneurysms of the Distal Segment of the Posterior Inferior Cerebellar Arteries: Clinical Presentation and Management
Dissecting Aneurysms of the Distal Segment of the Posterior Inferior Cerebellar Arteries: Clinical Presentation and Management
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DOI：
10.3174/ajnr.a2014
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发表时间：
2010-06-01
影响因子：
3.5
通讯作者：
David, C. A.
中科院分区：
文献类型：
--
作者：
Lim, S. M.;Choi, I. S.;David, C. A.
背景与目的：异食癖远段夹层动脉瘤是罕见的。本研究的目的是评估解剖异位动脉瘤的临床表现、影像学特征、治疗方案和临床结果。材料与方法：从1996年11月至2008年12月，在一家医疗中心的数据库中发现6例异食症远段夹层动脉瘤，并对其进行回顾性分析。分析治疗方式及随访临床结果。结果：5例解剖性异位动脉瘤患者表现为急性颅内出血，1例患者表现为颅内血肿引起的大肿块。5例颅内出血患者均行夹层异位动脉瘤及远端载动脉血管内闭塞治疗。腹壁内血肿患者行端对端吻合术。在1例患者中，尽管动脉瘤和母动脉都被血管内闭塞，但夹层动脉瘤在5年3个月的时间内复发两次。所有患者术后临床结果良好，无永久性神经系统并发症。结论：对于异位远段夹层动脉瘤的血管内治疗，我们建议同时闭塞夹层动脉瘤和载动脉，以避免对初始内膜撕裂点不进行治疗。我们所有的病人都有很好的临床结果；然而，我们在再通方面的经验表明需要对患者进行密切的随访。
BACKGROUND AND PURPOSE: Dissecting aneurysms of the distal segment of the PICA are rare. The purpose of this study was to evaluate the clinical presentations, imaging features, treatment options, and clinical outcomes of dissecting PICA aneurysms.MATERIALS AND METHODS: Six patients with dissecting aneurysms in the distal segments of PICA were found in the database of a single medical center, from November 1996 to December 2008, and retrospectively evaluated. Treatment mode and follow-up clinical outcomes were analyzed.RESULTS: Five patients with dissecting PICA aneurysms presented with acute intracranial hemorrhage and 1 patient presented with a large mass from an intramural hematoma. All 5 patients with intracranial hemorrhage were treated with endovascular occlusion of both the dissecting PICA aneurysm and the distal parent artery. The patient with the intramural hematoma underwent surgical trapping with end-to-end anastomosis. In 1 patient, the dissecting aneurysm recurred twice within a 5 year 3 month period, despite endovascular occlusion of both the aneurysm and the parent artery. The clinical outcome postprocedure was excellent in all patients, without permanent neurologic complication.CONCLUSIONS: For the endovascular treatment of dissecting aneurysms in the distal PICA segments, we recommend occlusion of both the dissecting aneurysm and the parent artery to avoid leaving the point of initial intimal tear untreated. All of our patients had excellent clinical outcomes; however, our experience with recanalization illustrates the need for close follow-up of patients.