Dinichert A, Rüfenacht D A, Tribolet N
Department of Neurosurgery, Hôpitaux Universitaires de Genève, Switzerland.
J Clin Neurosci. 2000 Nov;7(6):515-20. doi: 10.1054/jocn.2000.0757.
Dissecting aneurysms frequently involve the vertebral arteries and their branches, but those exclusively on the posterior inferior cerebellar artery (PICA) represent only 24 cases in the literature, including the four cases discussed in this article. The clinical diagnosis lacks pathognomonic signs or symptoms, with presentations such as subarachnoid haemorrhage or ischaemia of the brain stem or the cerebellum, and the management is controversial. Wrapping, clipping and embolisation of the aneurysms were tried in this series with different outcomes. Exclusion of the pathological segment should be performed, as shown by rebleeding from our case which was wrapped or by progression of the vascular disease in cases where treatment was delayed. Surgical or endovascular occlusion are well tolerated in our cases and in those reported from the literature, which implies the absence of normal perforating branches to the brain stem arising from the proximal dissected segment of the PICA and a good collateral circulation. A revascularisation procedure using the occipital artery can be performed in order to prevent infarction if an endovascular test occlusion is not tolerated.
夹层动脉瘤常累及椎动脉及其分支，但仅发生于小脑后下动脉（PICA）的夹层动脉瘤在文献中仅报道了24例，本文讨论的4例也包括在内。临床诊断缺乏特异性体征或症状，表现为蛛网膜下腔出血或脑干或小脑缺血，治疗存在争议。本系列尝试了对动脉瘤进行包裹、夹闭和栓塞，结果各异。应切除病变节段，如我们包裹治疗的病例出现再出血，或治疗延迟的病例出现血管疾病进展所示。在我们的病例以及文献报道的病例中，手术或血管内闭塞耐受性良好，这意味着PICA近端夹层节段没有正常的脑干穿支，且侧支循环良好。如果不能耐受血管内试验性闭塞，可以采用枕动脉进行血管重建手术以预防梗死。
