Watanabe Mitsuya, Inokuchi Sei, Kawamura Kaito, Fujita Naohide, Ueno Hideaki, Nakao Yasuaki, Yamamoto Takuji, Wada Ryo
Department of Neurosurgery, Juntendo University Shizuoka Hospital.
No Shinkei Geka. 2019 Jun;47(6):673-681. doi: 10.11477/mf.1436204003.
Two unusual cases of ruptured distal posterior inferior cerebellar artery(PICA)aneurysm on the cortical segment were successfully treated with open surgery. A 76-year-old woman presented with a Hunt and Kosnik(H&K)grade II Subarachnoid hemorrhage(SAH). CT showed a slight SAH in the cisterna magna and around the vermis, and fourth intraventricular hematoma. Cerebral angiography revealed an aneurysm on the cortical segment of the distal PICA. Intraoperative findings identified the aneurysm as fusiform. Trapping of the aneurysm was performed, and the indocyanine green angiography fiuding confirmed aneurysmal flow disappearance and good circulation in the cerebellar cortex. An 89-year-old woman presented with H&K grade II SAH. CT revealed a thick SAH in the posterior cranial fossa, and third to fourth intraventricular hematoma with hydrocephalus. Cerebral angiography revealed an aneurysm on the cortical segment of the distal PICA. Intraoperative findings showed that the aneurysm was fusiform. Trapping and resection of the aneurysm were performed. Thirteen previous cases of aneurysms on the cortical segment of the distal PICA have been reported. Distal PICA aneurysms apparently show rebleeding more frequently than do aneurysms at other locations, so immediate direct surgery is necessary to avoid rebleeding. After proximal ligation or trapping of the aneurysm, indocyanine green angiography is useful to determine the need for revascularization.
两例罕见的小脑后下动脉（PICA）远侧皮质段动脉瘤破裂患者通过开颅手术成功治愈。一名76岁女性，表现为Hunt和Kosnik（H&K）Ⅱ级蛛网膜下腔出血（SAH）。CT显示小脑延髓池和蚓部周围有轻度SAH，以及第四脑室内血肿。脑血管造影显示PICA远侧皮质段有一个动脉瘤。术中发现该动脉瘤为梭形。对动脉瘤进行了夹闭，吲哚菁绿血管造影结果证实动脉瘤血流消失，小脑皮质循环良好。一名89岁女性，表现为H&KⅡ级SAH。CT显示后颅窝有大量SAH，以及第三至第四脑室内血肿伴脑积水。脑血管造影显示PICA远侧皮质段有一个动脉瘤。术中发现动脉瘤为梭形。对动脉瘤进行了夹闭和切除。此前已有13例PICA远侧皮质段动脉瘤的报道。与其他部位的动脉瘤相比，PICA远侧动脉瘤显然更容易再出血，因此需要立即进行直接手术以避免再出血。在对动脉瘤进行近端结扎或夹闭后，吲哚菁绿血管造影有助于确定是否需要进行血管重建。
