摘要
目的探讨小脑上动脉动脉瘤的临床特征、诊断、鉴别诊断和治疗。方法回顾性收集川北医学院附属医院神经外科自2013年1月至2018年3月收治的16例小脑上动脉动脉瘤患者的临床资料,分析其临床表现、影像学特征、手术效果及诊治过程中存在的相关问题。结果16例患者中11例因动脉瘤破裂出血而发病,其中单纯蛛网膜下腔出血8例、蛛网膜下腔出血伴脑室积血3例,CT及CT血管成像(CTA)检查确诊8例为小脑上动脉动脉瘤、2例考虑为大脑后动脉动脉瘤、1例诊断不清;另5例因眼睑下垂3例、外展神经麻痹2例平诊就医,CT及CTA或MRI检查示2例考虑为脑干腹侧占位病变、3例诊断不清;最后所有患者行三维DSA检查明确诊断为小脑上动脉动脉瘤。5例首先选择介入栓塞治疗,其中1例因椎动脉狭窄迂曲置管困难改为开颅夹闭治疗;2例院外行介入栓塞治疗后因再次动脉瘤破裂出血转入我科行开颅夹闭治疗;9例直接选择开颅夹闭治疗。术后1例因小脑梗死及全身并发症长期卧床,余15例恢复良好,其中2例因脑积水加重行脑室腹腔分流术。结论小脑上动脉动脉瘤多以蛛网膜下腔出血发病,也可以动眼神经、外展神经麻痹和脑干旁占位表现发病;对于诊断不明或诊断部位不清又高度怀疑后循环动脉瘤的患者,应及早行三维DSA检查明确诊断;一旦明确诊断,应尽快采取干预措施,介入栓塞治疗可作为首选。
Objective To explore the clinical features,diagnoses,differential diagnoses and treatments of superior cerebellar artery aneurysms.Methods The clinical data of 16 patients with superior cerebellar artery aneurysms,admitted to our hospital from January 2013 to March 2018,were retrospectively collected.Their clinical manifestations,imaging features,surgical effects and related problems in the process of diagnoses and treatments were analyzed.Results Among the 16 patients,11 were caused by aneurysm rupture;8 had subarachnoid hemorrhage alone,and three had subarachnoid hemorrhage accompanied by ventricular hemorrhage;CT and CTA confirmed that 8 were superior cerebellar artery aneurysms,two were posterior cerebral artery aneurysms,and one was with unclear diagnosis.In the other 5 patients,three had eyelid ptosis and two had abducent nerve palsy;CT,CTA or MR imaging showed that two were considered as ventral brainstem occupying lesions,and three did not have clear diagnosis.Finally,all patients were diagnosed as having superior cerebellar artery aneurysms by three-dimensional DSA.Five patients were treated with interventional embolization first,and one was treated with surgical clipping because of vertebral artery stenosis and difficulty of catheter access;two patients were transferred to our department for surgical clipping due to aneurysm rupture after embolization treatment in other hospitals;and 9 patients were treated by surgical clipping directly.After treatments,one patient was in bed for a long time due to cerebellar infarction and systemic complications,and the other 15 patients recovered well;two of them underwent ventricular peritoneal shunt due to hydrocephalus.Conclusions Superior cerebellar artery aneurysm has onset of subarachnoid hemorrhage mostly,and oculomotor and abductor nerve paralysis,and space occupying manifestation around the brainstem sometimes.For patients with suspicious posterior circulation aneurysms whose diagnosis or location are unclear,three-dimensional DSA examination should be perfor
作者
唐晓平
段军伟
赵龙
彭华
张涛
杨彬彬
印晓鸿
李舜
孙浩耕
王远传
罗仁国
Tang Xiaoping;Duan Junwei;Zhao Long;Peng Hua;Zhang Tao;Yang Binbin;Yin Xiaohong;Li Shun;Sun Haogeng;Wang Yuanchuan;Luo Renguo(Department of Neurosurgery,Affiliated Hospital,North Sichuan University of Medical Sciences,Nanchong 637000,China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2019年第4期357-362,共6页
Chinese Journal of Neuromedicine
关键词
小脑上动脉
颅内动脉瘤
介入栓塞治疗
开颅夹闭治疗
Superior cerebellar artery aneurysm
Intracranial aneurysm
Interventional embolization
Surgical clipping
