D'Ambrosio Anthony L, Kreiter Kurt T, Bush Curtis A, Sciacca Robert R, Mayer Stephan A, Solomon Robert A, Connolly E Sander
Department of Neurological Surgery, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA.
Neurosurgery. 2004 Jul;55(1):39-50; discussion 50-4.
Proximal posteroinferior cerebellar artery (PICA) aneurysms are challenging to treat surgically, with high reported perioperative complication rates. We describe the perioperative course and long-term clinical outcomes obtained via a far lateral suboccipital approach in 20 consecutive proximal PICA aneurysms.
Data were collected prospectively on the first 20 proximal PICA aneurysms treated surgically by a single surgeon (ESC) between December 1997 and April 2003. All aneurysms were clipped via a far lateral approach. Patients with unruptured aneurysms were assessed at 3 and 12 months after surgery. For all subarachnoid hemorrhage patients, a battery of outcome tests was performed at 3- and 12-month intervals. Outcomes were then compared with those of a contemporaneously managed population of ruptured right-sided posterior communicating artery aneurysms.
The far lateral suboccipital approach achieved adequate exposure in all cases. There were no intraoperative complications or intraoperative aneurysm ruptures. All patients with unruptured aneurysms were fully functional at long-term follow-up. At 3 months of follow-up, 93% of the subarachnoid hemorrhage patients achieved a Glasgow Outcome Scale score of 1 to 2. At 12 months of follow-up, 92% achieved a Glasgow Outcome Scale score of 1 to 2. Compared with the patients with a ruptured right-sided posterior communicating artery aneurysm, no difference could be found in quality of life or activities of daily living at either time point.
The favorable outcomes and low postoperative morbidity in this subset of patients argues that clipping via this approach be considered a first-line therapeutic option. When performed in this manner, PICA aneurysm surgery seems to have no greater morbidity than right-sided posterior communicating artery aneurysm surgery.
小脑后下动脉近端（PICA）动脉瘤的手术治疗具有挑战性，据报道围手术期并发症发生率很高。我们描述了通过远外侧枕下入路对20例连续性近端PICA动脉瘤进行手术的围手术期过程及长期临床结果。
前瞻性收集1997年12月至2003年4月间由单一外科医生（ESC）手术治疗的前20例近端PICA动脉瘤的数据。所有动脉瘤均通过远外侧入路夹闭。未破裂动脉瘤患者在术后3个月和12个月进行评估。对于所有蛛网膜下腔出血患者，在术后3个月和12个月间隔进行一系列结局测试。然后将结果与同期治疗的右侧后交通动脉瘤患者群体的结果进行比较。
远外侧枕下入路在所有病例中均实现了充分暴露。术中无并发症或动脉瘤破裂。所有未破裂动脉瘤患者在长期随访中功能完全正常。在随访3个月时，93%的蛛网膜下腔出血患者格拉斯哥预后评分达到1至2分。在随访12个月时，92%的患者格拉斯哥预后评分达到1至2分。与右侧后交通动脉瘤破裂患者相比，在两个时间点的生活质量或日常生活活动方面均未发现差异。
该组患者的良好结局和低术后发病率表明，通过这种入路夹闭应被视为一线治疗选择。以这种方式进行手术时，PICA动脉瘤手术的发病率似乎并不高于右侧后交通动脉瘤手术。
