Hudgins R J, Day A L, Quisling R G, Rhoton A L, Sypert G W, Garcia-Bengochea F
J Neurosurg. 1983 Mar;58(3):381-7. doi: 10.3171/jns.1983.58.3.0381.
The clinical and anatomical features of 21 surgically treated saccular aneurysms of the posterior inferior cerebellar artery (PICA) are analyzed. Seventeen of these lesions originated from the PICA-vertebral junction, and four arose from distal PICA branching sites. Twelve lesions arose from the left PICA, nine were right-sided, and all were small (less than 12.5 mm). Most of these aneurysms occurred in females (16 of 21) and presented as classic subarachnoid hemorrhage. The lack of specific focal deficits prevented an accurate pre-angiographic determination of aneurysm location in most instances. Clinically significant vasospasm and aneurysm multiplicity occurred with approximately equal frequency as at other locations. The angiographic and surgical features of these lesions are determined by the course of the vertebral artery and PICA; that is, they occur at branching sites and at curves in the parent vessel, and point in the direction in which flow would have continued if the curve at the aneurysm's origin had not been present. Aneurysms at the PICA-vertebral junction usualthese lesions are determined by the course of the vertebral artery and PICA; that is, they occur at branching sites and at curves in the parent vessel, and point in the direction in which flow would have continued if the curve at the aneurysm's origin had not been present. Aneurysms at the PICA-vertebral junction usualthese lesions are determined by the course of the vertebral artery and PICA; that is, they occur at branching sites and at curves in the parent vessel, and point in the direction in which flow would have continued if the curve at the aneurysm's origin had not been present. Aneurysms at the PICA-vertebral junction usually occur at least 1 cm above the foramen magnum level, arise distal to the PICA origin in the angle between the two vessels, and are best approached by a paramedian incision with the patient in the lateral recumbent position. Isolated clipping of the aneurysm neck is essential in this instance, as trapping may compromise vital perforating arteries of the brain stem. More distal (retromedullary) PICA aneurysms are sometimes associated with another vascular anomaly (two cases in this series), and are best handled through a bilateral suboccipital craniectomy. Clipping of the neck is the preferred treatment, but trapping is usually safe, if necessary.
分析了21例经手术治疗的小脑后下动脉（PICA）囊状动脉瘤的临床和解剖学特征。其中17个病变起源于PICA - 椎动脉交界处，4个起源于PICA远端分支部位。12个病变起源于左侧PICA，9个在右侧，且均为小动脉瘤（直径小于12.5mm）。这些动脉瘤大多发生在女性（21例中有16例），表现为典型的蛛网膜下腔出血。在大多数情况下，由于缺乏特定的局灶性缺损，术前血管造影难以准确确定动脉瘤的位置。临床上显著的血管痉挛和动脉瘤多发的发生率与其他部位大致相同。这些病变的血管造影和手术特征取决于椎动脉和PICA的走行；也就是说，它们发生在分支部位和母血管的弯曲处，并指向如果动脉瘤起源处没有弯曲时血流会继续的方向。PICA - 椎动脉交界处的动脉瘤通常发生在枕骨大孔水平上方至少1cm处，起源于PICA起始部远端，位于两血管夹角内，患者侧卧位时经旁正中切口最易到达。在这种情况下，孤立夹闭动脉瘤颈部至关重要，因为圈套术可能会损害脑干的重要穿通动脉。更靠远端（延髓后）的PICA动脉瘤有时与另一种血管异常相关（本系列中有2例），最好通过双侧枕下颅骨切除术处理。夹闭颈部是首选治疗方法，但必要时圈套术通常也是安全的。
