摘要： 目的 探讨椎动脉颅内段夹层动脉瘤的个体化治疗策略。方法 分别采用微弹簧圈闭塞动脉瘤和载瘤动脉、支架辅助微弹簧圈栓塞动脉瘤、单纯支架植入、手术直接夹闭动脉瘤，以及枕动脉-小脑后下动脉血管吻合术辅助微弹簧圈闭塞动脉瘤和载瘤动脉等方法治疗18 例椎动脉颅内段夹层动脉瘤患者。结果 18 例患者中5 例采用微弹簧圈闭塞动脉瘤和载瘤动脉，5 例行支架辅助微弹簧圈栓塞动脉瘤（3 例基本致密栓塞、2 例非致密栓塞），4 例行单纯支架植入术（术后3 例动脉瘤血流动力学改善），3例经远外侧入路手术直接夹闭动脉瘤，1例行枕动脉-小脑后下动脉血管吻合术辅助微弹簧圈闭塞动脉瘤和载瘤动脉。其中2 例术中动脉瘤破裂出血，1 例死亡、1 例中残；1 例闭塞动脉瘤和载瘤动脉患者，术后出现短暂性吞咽困难和偏侧肢体麻木，其余患者术后平稳。17 例获得1 个月至3 年随访，无一例动脉瘤复发或进展。结论 用于治疗椎动脉颅内段夹层动脉瘤的方法有多种，选择治疗方案时需考虑动脉瘤是否破裂出血或引起脑梗死，以及动脉瘤形态（如局限性偏侧型）、是否位于优势侧、是否累及小脑后下动脉等因素，根据患者具体情况制定个体化治疗方案。

关键词: 动脉瘤, 夹层, 栓塞, 治疗性, 椎动脉, 脑血管重建术

Abstract: Objective To discuss the individualized management strategy for intracranial vertebral artery dissecting aneurysms. Methods Eighteen patients with intracranial vertebral artery dissecting aneurysms were treated with different surgical methods. Results Eighteen patients underwent different surgical treatment. Five patients underwent complete occlusion of the aneurysm and parent artery by coiling, 5 were treated by stent -assisted coiling (3 densely packed coiling and 2 non-densely packed coiling), 4 underwent stent-only therapy and 3 of them presented hemodynamic improvement after surgery, 3 were treated by direct surgical clipping, and 1 underwent occipital artery-posterior inferior cerebellar artery bypass. Two aneurysms ruptured immaturely, in which one patient died on the third day after operation and one patient occurred moderate disablity. Only 1 patient who underwent complete occlusion of aneurysm and parent artery presented temporarily ischemic symptoms. No adverse effects were seen in other patients. Seventeen patients were followed up for 1 month to 3 years, and all the aneurysms were stable. Conclusion There are many kinds of therapeutic methods for intracranial vertebral artery dissecting aneurysms. The patients should be treated according to several factors such as the clinical manifestations, aneurysm configuration, and relationship with the posterior inferior cerebellar artery. The treatment should be individualized.

Key words: Aneurysm, dissecting, Embolization, therapeutic, Vertebral artery, Cerebral revascularization