小脑前下动脉瘤11例临床分析

doi:10.3969/j.issn.1673-5765.2020.06.011

摘要/Abstract

摘要：

目的总结小脑前下动脉瘤的临床和影像学特点，以及手术夹闭与介入治疗两种方法的治疗效果。方法回顾性分析首都医科大学附属北京天坛医院神经外科2012年1月-2019年12月收治的小脑前下动脉瘤患者的基线信息、临床表现、动脉瘤特点、治疗方式和治疗效果。结果共收治11例小脑前下动脉瘤患者，其中显微外科手术夹闭动脉瘤5例，治愈率100%，术后2例（40%）出现不完全性失语和手术侧面瘫，随访均无复发；介入治疗6例，5例（83.3%）完全栓塞动脉瘤，其中2例（33.3%）闭塞动脉瘤远端载瘤动脉，1例（16.7%）栓塞治疗失败，术后1例（16.7%）出现记忆力下降，1例（16.7%）出院1个月后动脉瘤破裂，并最终死亡。结论对于小脑前下动脉瘤，积极干预对于挽救患者生命意义重大，开颅手术夹闭和介入治疗都是可选的治疗方式，两者均效果确切。

文章导读： 本文以较为罕见的小脑前下动脉瘤为研究对象，选取单中心11例患者进行回顾性临床分析，并通过对比两种治疗手段在治疗效果、并发症和复发率等方面的差异，得出手术夹闭和介入治疗均是可靠的治疗手段，为小脑前下动脉瘤的临床治疗选择提供借鉴。

关键词: 小脑前下动脉瘤; 动脉瘤夹闭; 介入栓塞治疗

Abstract:

Objective To summarize the clinical characteristics of 11 cases of anterior inferior cerebellar artery (AICA) aneurysms and compare the efficacy of two treatment approaches of neurosurgical clipping and endovascular coiling. Methods Clinical data of patients with AICA aneurysms admitted to Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University from 2012 January to 2019 December were retrospectively analyzed. The clinical data included the baseline information, clinical presentation, aneurysm feature, treatment way and clinical outcome. Results A total of 11 cases were included, including 5 cases with neurosurgical treatment and 6 cases with endovascular treatment. The surgical success rate of neurosurgery group was 100%, with no recurrent aneurysms during the follow-up period, and partial aphasia and operation-ipsilateral facioplegia occurred in 2 cases (40%) after operation. Of 6 cases with endovascular treatment, there were 5 cases of successful endovascular coiling and 1 failure case, 1 of 5 successful cases died from re-ruptured aneurysm at 1 month after discharge, and dysmnesia occurred in 1 case after operation. Conclusions Both neurosurgical clipping and endovascular coiling are feasible and effective treatment approaches for patients with AICA aneurysms.

Key words: Anterior inferior cerebellar artery aneurysm; Aneurysm clipping; Endovascular coiling

陈鑫，王昊，姜朋军，焦玉明，曹勇，李佑祥，王硕. 小脑前下动脉瘤11例临床分析[J]. 中国卒中杂志, 2020, 15(06): 631-636.

CHEN Xin, WANG Hao,JIANG Peng-Jun, JIAO Yu-Ming, CAO Yong, LI You-Xiang, WANG Shuo. Clinical Analysis of 11 Cases of Anterior Inferior Cerebellar Artery Aneurysms[J]. Chinese Journal of Stroke, 2020, 15(06): 631-636.

参考文献

[1] INCI S，SPETZLER R E. Intracranial aneurysms

and arterial hypertension：a review and hypothesis[J].

Surg Neurol，2014，53（6）：530-542.

[2] SUN Y，WREDE K H，CHEN Z，et al. Ruptured

intrameatal AICA aneurysms-a report of two cases

and review of the literature[J]. Acta Neurochir

（Wien），2009，151（11）：1525-1530.

[3] LV X L，GE H J，HE H W，et al. Anterior inferior

cerebellar artery aneurysms：segments and results

of surgical and endovascular managements[J]. Interv

Neuroradiol，2016，22（6）：643-648. [4] KRZYZEWSKI R M，KLIS K M，KUCALA

R，et al. Intracranial aneurysm distribution

and characteristics according to gender[J]. Br J

Neurosurg，2018，32（5）：541-543.

[5] HAMDAN A，BARNES J，MITCHELL P.

Subarachnoid hemorrhage and the female sex：

analysis of risk factors，aneurysm characteristics，

and outcomes[J]. J Neurosurg，2014，121（6）：1367-

1373.

[6] AARHUS M，HELLAND C A，WESTER K.

Differences in anatomical distribution，gender，

and sidedness between ruptured and unruptured

intracranial aneurysms in a defined patient

population[J]. Acta Neurochir（Wien），2009，151

（12）：1569-1574.

[7] EDEN S V，MEURER W J，SÁNCHEZ B N，et

al.Gender and ethnic differences in subarachnoid

hemorrhage[J]. Neurology，2008，71（10）：731-735.

[8] CARANCI F，BRIGANTI F，CIRILLO L，et

al. Epidemiology and genetics of intracranial

aneurysms[J]. Eur J Radiol，2013，82（10）：1598-

1605.

[9] 中国高血压防治指南修订委员会，高血压联盟中国

中华医学会心血管病学分会，中国医师协会高血压专

业委员会，等. 中国高血压防治指南（2018年修订版）

[J]. 中国心血管杂志，2019，24（1）：24-56.

[10] 中华医学会. 597例颅内动脉瘤住院患者患高血压

情况分析[J]. 第九届中国健康服务业大会暨中华医

学会第七次全国健康管理学学术会议论文集，2015：

1-3.

[11] LINDGREN A E，KURKI M I，RIIHINEN A，et

al. Hypertension predisposes to the formation of

saccular intracranial aneurysms in 467 unruptured

and 1053 ruptured patients in Eastern Finland[J].

Ann Med，2014，46（3）：169-176.

[12] KANG H G，KIM BJ，LEE J，et al. Risk factors

associated with the presence of unruptured

intracranial aneurysms[J]. Stroke，2015，46（11）：

3093-3098.

[13] MOLYNEUX A J，KERR R S，YU L M，et al.

International subarachnoid aneurysm trial（ISAT）of

neurosurgical clipping versus endovascular coiling

in 2143 patients with ruptured intracranial aneurysms：

a randomised comparison of effects on survival，

dependency，seizures，rebleeding，subgroups，and

aneurysm occlusion[J]. Lancet，2005，366（9488）：

809-817.

[14] NGUYEN T H，PHAM V T，PHAM Q T，et al.

Successful clipping of a giant anterior inferior

cerebellar artery aneurysm with combined

transpetrosal approach[J]. Case Rep Neurol Med，

2019，2019：6049573.

[15] 刘建刚，杜洪宇，张世明，等. 小脑前下动脉动脉瘤

的手术治疗与文献复习附四例报告[J]. 中华神经外

科杂志，2015，31（1）：34-35.

[16] RHOTON A L Jr. The cerebellar arteries[J].

Neurosurgery，2000，47（Suppl 3）：S29-S68.

[17] PELUSO J P，VAN ROOIJ W J，SLUZEWSKI M，et

al. Distal aneurysms of cerebellar arteries：incidence，

clinical presentation，and outcome of endovascular

parent vessel occlusion[J]. AJNR Am J Neuroradiol，

2007，28（8）：1583-1578.

[18] 高恺明，佟小光. 破裂小脑前下动脉动脉瘤的外科治

疗[J]. 中国现代神经疾病杂志，2013，13（3）：201-

210.