摘要
目的探讨破裂小脑下前动脉瘤患者的临床特征及治疗效果。方法回顾性连续纳入2009年9月至2022年9月于苏州大学附属第一医院神经外科住院治疗的破裂小脑下前动脉瘤患者。收集患者的临床资料(年龄、性别、既往史、临床症状、Hunt-Hess分级、影像学资料等)、治疗方式(显微手术治疗和血管内治疗)、治疗安全性(术前或术中动脉瘤有无再次破裂出血,术后有无新发颅内出血、梗死以及新发神经功能缺损等)、疗效(动脉瘤是否完全夹闭或栓塞完全及术后神经功能改善情况,栓塞效果采用改良Raymond-Roy分级评估)及随访情况(影像学随访和临床随访)。结果共计纳入17例破裂小脑下前动脉瘤患者,其中男5例,女12例;年龄24~77岁,平均(52±14)岁;4例患者既往有高血压病史,1例合并甲状腺功能亢进,1例既往有系统性血管炎病史。5例患者动脉瘤位于脑桥前段,7例位于脑桥外侧段,1例位于绒球段,4例位于皮质段。入院Hunt-Hess分级:Ⅱ级13例,Ⅲ级3例,Ⅴ级1例。显微手术治疗10例,血管内治疗7例。所有显微手术治疗患者动脉瘤均完全夹闭,血管内治疗患者术后即刻DSA评估动脉瘤改良Raymond-Roy分级均为Ⅰ级栓塞。安全性事件包括术前动脉瘤再次破裂出血1例,术中发生动脉瘤破裂1例,术后面瘫1例。术后6个月随访,6例患者完成影像学随访,动脉瘤均未见复发;随访改良Rankin量表评分0分14例,1分1例,3分1例,4分1例。结论破裂小脑下前动脉瘤多见于中年、女性患者,且动脉瘤多数位于小脑下前动脉近端。针对破裂小脑下前动脉瘤,显微手术治疗和血管内治疗各有利弊,但两种治疗方式均可取得满意疗效。
Objective To summarize the clinical characteristics and treatment efficacy of ruptured anterior inferior cerebellar artery(AICA)aneurysms.Methods We retrospectively included patients with ruptured AICA aneurysms who admitted to the Department of Neurosurgery,First Affiliated Hospital of Soochow University from September 2009 to September 2022 consecutively.The clinical data(age,sex,past medical history,clinical symptoms,Hunt-Hess grade,imaging data,etc.),treatment methods(neurosurgical clipping and endovascular treatment),safety of treatment(whether the aneurysm ruptured again before or during the operation,whether there was new intracranial hemorrhage,infarction and new neurological function defect after the operation,etc.),efficacy(whether the aneurysm was clipped or embolized completely,the improvement of neurological function after the operation,the embolization effect was evaluated using the modified Raymond-Roy classification)and follow-up(imaging and clinical data)were collected.Results A total of 17 cases were included.There were 5 males and 12 females;the age ranged from 24 to 77 years,with an average age of(52±14)years.There were 4 patients with a history of hypertension,1 with hyperthyroidism,and 1 with a history of systemic vasculitis.The aneurysms were located at the anterior pontine segment of AICA in 5 cases,the lateral pontomedullary segment in 7 cases,the flocculonodular segment in 1 case,and the cortical segment in 4 cases.Admission Hunt-Hess grading of the patients:13 cases were gradeⅡ,3 cases were gradeⅢ,and 1 case was gradeⅤ.Neurosurgical clipping was applied in 10 cases and endovascular treatment was applied in 7 cases.Aneurysms were clipped completely in all patients treated with microsurgery,and the modified Raymond-Roy classification for aneurysms in all patients treated with endovascular therapy immediately after surgery was gradeⅠembolization.Security events included 1 case of pre-operative aneurysm re-rupture and bleeding,1 case of intraoperative aneurysm rupture,and 1 case of
作者
马超
王紫兰
朱昀
尤万春
陈周青
王中
Ma Chao;Wang Zilan;Zhu Yun;You Wanchun;Chen Zhouqing;Wang Zhong(Department of Neurosurgery,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2022年第12期831-840,共10页
Chinese Journal of Cerebrovascular Diseases
基金
苏州市第五批姑苏卫生人才培养项目(GSWS2019002)。
关键词
小脑下前动脉
动脉瘤
手术夹闭
介入治疗
Anterior inferior cerebellar artery
Aneurysms
Surgical clipping
Endovascular treatment
