Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
J Neurointerv Surg. 2013 Nov;5(6):546-51. doi: 10.1136/neurintsurg-2012-010557. Epub 2012 Nov 23.
Posterior circulation perforator artery aneurysms are sparsely reported in the literature. The natural history of these rare lesions remains unclear and their diagnosis and management are not well-defined.
We reviewed our institution's medical records and performed a comprehensive literature search for cases of posterior circulation perforator aneurysms. Diagnostic imaging, management and clinical outcomes were the primary components of interest.
Our first case was a 58-year-old patient who developed an infarct after attempted endovascular treatment of a basilar perforator artery aneurysm, the second case was a 55-year-old patient with a posterior cerebral artery perforator aneurysm who did well with conservative management and the third case was a 68-year-old patient who suffered an infarct after successful Onyx embolization of a superior cerebellar artery perforator aneurysm. From the literature we identified four case reports and four case series, all describing aneurysmal lesions of the basilar perforator arteries, giving a total of 17 cases including those from our institution. All cases presented with subarachnoid hemorrhage although 47% of initial vascular imaging studies failed to reveal the aneurysm. Cumulatively, 41% of patients were treated with microsurgery, 35% were treated with endovascular therapy and 24% were managed conservatively with subsequent spontaneous aneurysm resolution at a mean interval of 10 months after rupture.
Perforator aneurysms of the posterior circulation are diagnostic and therapeutic challenges. Both microsurgical and endovascular treatment of posterior circulation perforator aneurysms are technically difficult, necessitating comprehensive management by an experienced cerebrovascular team.
后循环穿支动脉动脉瘤在文献中报道较少。这些罕见病变的自然病史尚不清楚，其诊断和治疗也尚未明确。
我们回顾了我们机构的病历，并对后循环穿支动脉动脉瘤的病例进行了全面的文献检索。诊断影像学、治疗和临床结果是主要关注的内容。
我们的第一个病例是一位 58 岁的患者，在试图对基底动脉穿支动脉动脉瘤进行血管内治疗后发生梗死；第二个病例是一位 55 岁的患者，患有大脑后动脉穿支动脉瘤，保守治疗效果良好；第三个病例是一位 68 岁的患者，在成功进行小脑上动脉穿支动脉瘤 Onyx 栓塞后发生梗死。通过文献检索，我们确定了 4 个病例报告和 4 个病例系列，所有这些都描述了基底动脉穿支动脉的动脉瘤病变，包括我们机构的病例在内，总共 17 例。所有病例均表现为蛛网膜下腔出血，尽管 47%的初始血管影像学检查未能显示动脉瘤。累积起来，41%的患者接受了显微手术治疗，35%的患者接受了血管内治疗，24%的患者接受了保守治疗，在破裂后平均 10 个月内自发性动脉瘤消退。
后循环穿支动脉动脉瘤是诊断和治疗的挑战。后循环穿支动脉动脉瘤的显微手术和血管内治疗均具有技术难度，需要有经验的脑血管病团队进行全面管理。
