摘要：

目的 探讨小脑后下动脉动脉瘤的治疗方法。方法 分别采用动脉瘤栓塞术、动脉瘤夹 闭术和血管吻合术联合动脉瘤栓塞术治疗80 例小脑后下动脉动脉瘤患者，总结3 种手术方式适应证和 技术特点。结果 80 例患者中行动脉瘤栓塞术49 例，手术成功率约为95.92%（47/49）；行动脉瘤夹闭术19 例，手术成功率为16/19；行枕动脉-小脑后下动脉吻合术联合动脉瘤栓塞术12 例，手术成功率为11/12。2 例术后死亡，21 例出现神经功能缺损症状，其余57 例均好转。术后平均随访3.65 年，复查CTA 或 DSA 显示7 例动脉瘤复发。结论 小脑后下动脉动脉瘤栓塞术手术创伤较小、手术时间较短；对于后循环血管迂曲、动脉瘤较小、瘤颈较宽者，动脉瘤夹闭术相对安全且简单易行；对于动脉瘤栓塞术和夹闭术 均较困难者，血管吻合术联合动脉瘤栓塞术为最后选择。

关键词: 颅内动脉瘤, 小脑, 神经外科手术

Abstract:

Objective  To summarize the experience of treating posterior inferior cerebellar artery (PICA) aneurysms.  Methods  A total of 80 cases of PICA aneurysms were respectively treated by interventional embolization (49 cases), clipping (19 cases) and anastomosis of occipital artery (OA) and PICA combined with embolization (12 cases). The indications and technical features of three kinds of surgeries were summarized. Results Interventional embolization was applied to 49 cases, with a success rate of 95.92% (47/49). Clipping was applied to 19 cases, with a success rate of 16/19. Anastomosis of OA and PICA combined with embolization was applied to other 12 cases, with a success rate of 11/12. In all of 80 cases, 2 cases were ended up to death after surgery, 21 cases were found neurological deficiency, such as dysphagia, hoarseness and limb dyskinesia, and other 57 cases were greatly improved. The mean follow-up period was 3.65 years, and 7 cases were found recurrent aneurysms in the reexamination of computed tomography angiography (CTA) or digital subtraction angiography (DSA).  Conclusions  Interventional embolization has relatively small incision and short operation time, while clipping is safe and feasible for patients with tortuous posterior circulation blood vessels, small aneurysms and wide aneurysm neck. For patients who have difficulty in undergoing embolization and clipping, anastomosis of arteries combined with embolization is the final choice.

Key words: Intracranial aneurysm, Cerebellum, Neurosurgical procedures