Yamaguchi N, Miyazaki H, Ishiyama N, Toya S
Department of Neurosurgery, Hiratsuka City Hospital, Kanagawa.
Neurol Med Chir (Tokyo). 1996 Jan;36(1):31-5. doi: 10.2176/nmc.36.31.
A 41-year-old male presented with vertigo, nausea, and vomiting suggesting a space-occupying lesion of the posterior fossa. Computed tomography (CT) and left vertebral angiography revealed a large distal posterior inferior cerebellar artery (PICA) aneurysm. Operation revealed the fusiform aneurysm was partially embedded in the medulla, preventing neck clipping or trapping of the aneurysm. Therefore, proximal ligation of the PICA was performed. The symptoms caused by the mass effect improved, and the aneurysm was not visualized by CT or angiography. Ligation of the PICA proximal to the choroidal point is not necessarily safe. In our case, ligation was distal to the tonsillomedullary segment from which the perforating arteries mainly arose, so the postoperative course was good without new neurological deficits. Proximal ligation is an effective treatment for distal PICA aneurysms manifesting as mass effect if other interventions are not possible.
一名41岁男性出现眩晕、恶心和呕吐症状，提示后颅窝有占位性病变。计算机断层扫描（CT）和左椎动脉血管造影显示小脑后下动脉（PICA）远端有一个大型动脉瘤。手术发现梭形动脉瘤部分嵌入延髓，无法进行瘤颈夹闭或动脉瘤包裹术。因此，对PICA进行了近端结扎。由占位效应引起的症状有所改善，CT或血管造影未显示动脉瘤。在脉络丛点近端结扎PICA不一定安全。在我们的病例中，结扎部位在穿支动脉主要发出的扁桃体延髓段远端，因此术后病程良好，没有出现新的神经功能缺损。如果无法进行其他干预，近端结扎是治疗表现为占位效应的PICA远端动脉瘤的有效方法。
