Sejkorová Alena, Petr Ondra, Mulino Miriam, Cihlář Jiří, Hejčl Aleš, Thomé Claudius, Sameš Martin, Lanzino Giuseppe
Neurosurgery Department, J.E. Purkynje University, Masaryk Hospital, Sociální péče 3316/12A, 400 11, Ústí nad Labem, Czech Republic.
Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
Acta Neurochir (Wien). 2017 Mar;159(3):549-558. doi: 10.1007/s00701-016-3058-z. Epub 2017 Jan 9.
Posterior inferior cerebellar artery (PICA) aneurysms are an uncommon, heterogeneous group of aneurysms with poorer clinical outcomes compared to other intracranial aneurysms. We performed a multicenter retrospective study to analyze the outcome in a large series of patients treated with modern microsurgical and endovascular techniques.
Records of 94 patients treated for PICA aneurysms between 2000 and 2015 at three large tertiary referral centers were retrospectively reviewed.
Eighty-three patients met inclusion criteria and of these, two died before treatment, leaving 81 treated patients (43 underwent endovascular and 38 surgical treatment). Among patients treated endovascularly, procedure-related complications occurred in four cases (11.8%). Six patients (19.4%) suffered from complications directly associated with surgery. Recurrences occurred in 0% of surgical and in 16.3% of endovascularly treated patients, requiring treatment. Patients with unruptured asymptomatic aneurysms had good outcomes. In the group of 67 ruptured aneurysms, 16 endovascularly (47.1%) and 15 surgically (48.4%) treated patients had modified Rankin scale (mRS) scores of 3-6. Of patients in poor neurological condition (Hunt & Hess (H&H) IV-V at admission), 84.6% suffered a poor clinical outcome. Fifty percent of patients with distal and 31.9% patients with proximal ruptured PICA aneurysms suffered a poor neurological outcome.
This study of PICA aneurysms demonstrates that results of both treatment modalities are comparable. However, endovascular treatment is associated with higher risks of recurrence, requiring additional treatment. Outcomes were mostly impacted by clinical state at admission.
小脑后下动脉（PICA）动脉瘤是一组少见的、异质性的动脉瘤，与其他颅内动脉瘤相比，其临床预后较差。我们进行了一项多中心回顾性研究，以分析大量采用现代显微外科和血管内技术治疗的患者的预后情况。
回顾性分析了2000年至2015年间在三家大型三级转诊中心接受PICA动脉瘤治疗的94例患者的记录。
83例患者符合纳入标准，其中2例在治疗前死亡，剩余81例接受治疗的患者（43例行血管内治疗，38例行手术治疗）。在接受血管内治疗的患者中，4例（11.8%）发生了与手术相关的并发症。6例（19.4%）患者出现了与手术直接相关的并发症。手术治疗患者的复发率为0%，血管内治疗患者的复发率为16.3%，复发患者需要进一步治疗。未破裂无症状动脉瘤患者预后良好。在67例破裂动脉瘤患者中，血管内治疗的16例（47.1%）和手术治疗的15例（48.4%）患者改良Rankin量表（mRS）评分为3 - 6分。入院时神经功能状态较差（Hunt & Hess（H&H）IV - V级）的患者中，84.6%临床预后不良。PICA动脉瘤远端破裂患者中有50%、近端破裂患者中有31.9%神经功能预后不良。
这项关于PICA动脉瘤的研究表明，两种治疗方式的结果具有可比性。然而，血管内治疗的复发风险较高，需要额外治疗。预后主要受入院时临床状态的影响。
