Microsurgery and endovascular treatment of posterior inferior cerebellar artery aneurysms
Microsurgery and endovascular treatment of posterior inferior cerebellar artery aneurysms
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小脑后下动脉瘤的显微外科和血管内治疗
DOI：
10.1007/s10143-015-0659-6
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发表时间：
2015
影响因子：
2.8
通讯作者：
M. Sameš
中科院分区：
文献类型：
--
作者：
Alena Sejkorová;F. Cihlář;A. Hejčl;J. Lodin;P. Vachata;M. Sameš
位于小脑后下动脉的动脉瘤是罕见的，其治疗指南尚未建立。本文介绍了一项回顾性研究的结果，该研究分析了2004年至2013年15例小脑后下动脉瘤患者的管理和治疗。动脉瘤破裂并出现蛛网膜下腔出血。15个动脉瘤中，10个为囊状动脉瘤，3个为梭形动脉瘤，2个为夹层动脉瘤。计算机断层扫描血管造影或数字减影血管造影显示其他动脉瘤或脑内动脉发育不全7例。根据动脉瘤的位置和形态进行手术或血管内治疗。6个动脉瘤被弹簧圈栓塞，9个病例进行了手术。在9例手术治疗的患者中，6例（75%）结局良好。在使用血管内手术治疗的6例患者中，3例患者（50%）痊愈。使用Hunt&Hess量表对患者结局进行分类。Hunt&Hess 1-3的患者恢复，无神经功能缺损。另一方面，Hunt&Hess评分为4-5的患者有高达93%的死亡风险或预后不良。在2例血管内治疗和2例治疗前的病例中，发生了动脉瘤性再出血，导致患者临床状态恶化，预后不良，死亡风险高。本研究显示急性治疗小脑后下动脉瘤的必要性，彻底的诊断和跨学科合作。
Aneurysms located on the posterior inferior cerebellar artery are rare, and treatment guidelines for them have not yet been established. In this paper, we present the results of a retrospective study which analyzes the management and treatment of 15 patients with posterior inferior cerebellar artery aneurysms from 2004 to 2013. The aneurysms were ruptured and presented with a subarachnoid hemorrhage. Of the 15 aneurysms, ten were of saccular, three fusiform, and two were dissecting. Computed tomography angiography or digital subtraction angiography revealed other aneurysms or intracerebral artery hypoplasia in seven patients. Either surgical or endovascular treatment was performed depending on the localization and morphology of the aneurysm. Six aneurysms were coiled, and surgery was performed in nine cases. Of the nine surgically treated patients, six (75 %) had good outcomes. Of the six patients treated using endovascular procedures, three patients (50 %) recovered. Patient outcomes were classified using the Hunt&Hess scale. Patients with Hunt&Hess 1–3 recovered without a neurological deficit. On the other hand, patients with Hunt&Hess 4–5 had a risk of up to 93 % of death or a poor outcome. In two cases of endovascular and in two cases before any therapy, aneurysmal rebleeding occurred and resulted in deterioration of clinical state of the patient and a poor prognosis with high risk of death. This study shows the necessity of acute treatment of posterior inferior cerebellar artery aneurysm, of thorough diagnostic, and of interdisciplinary cooperation.