Blard J M, Finiels P J, Combalbert A, Vlahovitch B, Frerebeau P, Grellier P, Privat J M, Finiels H, Pages M, Heroum C
Service de Neurochirurgie, Hôpital Ste-Marguerite, Marseille.
Rev Neurol (Paris). 1997 Feb;153(1):41-50.
A multicenter retrospective study of 29 cases of posterior inferior cerebellar artery is reported. Over a period of 21 years, the frequency of posterior inferior cerebellar artery aneurysm among all intracranial aneurysm was estimated to 1.38 p. 100 of cases of aneurysms followed by 3 University Hospitals. Frequency of rupture appeared to be very high (93 p. 100) in this series probably because of the type of selection. Average grade of presentation according to Hunt and Hess classification being < III in 3 fourth of the cases. Neither clinical presentation nor suspicious etiological factors were specific of this localization. Only two cases were of pseudotumoral appearance. Positive diagnosis of subarachnoid hemorrhage was made by CT scan. Angiograms gave diagnosis of localization of the malformation and its type. Intraventricular hemorrhage was found in 62 p. 100 of our cases: all had hemorrhage of the fourth ventricle. Hydrocephaly was more frequent as compared to supratentorial localizations, Vasospasm was less frequent as in supratentorial localizations. Nimodipin seems to be efficient. Therapeutic possibilities are primary dominated by surgery with good results when it is possible. Endovascular treatment is under evaluation.
本文报道了一项对29例小脑后下动脉病例的多中心回顾性研究。在21年的时间里，在3所大学医院随访的所有颅内动脉瘤病例中，小脑后下动脉瘤的发生率估计为1.38‰。在该系列中，破裂发生率似乎非常高（93%），这可能是由于选择类型的原因。根据Hunt和Hess分级，四分之三的病例就诊时平均分级<Ⅲ级。临床表现和可疑病因均不具有该部位的特异性。仅2例表现为假瘤样外观。蛛网膜下腔出血的阳性诊断通过CT扫描做出。血管造影可诊断畸形的部位及其类型。我们的病例中有62%发现了脑室内出血：均为第四脑室出血。与幕上部位相比，脑积水更为常见，血管痉挛则较幕上部位少见。尼莫地平似乎有效。治疗方法主要以手术为主，若有可能，手术效果良好。血管内治疗正在评估中。
