分析破裂性小脑后下动脉远端动脉瘤介入治疗的安全性和有效性，以及伴随的血管畸形的处理策略。

回顾性纳入南京大学医学院附属鼓楼医院神经外科2015年1月至2021年3月收治的33例破裂性小脑后下动脉远端动脉瘤患者的临床资料，术后6个月行脑血管造影复查，术后6个月、12个月分别进行临床随访。

33例破裂性小脑后下动脉远端动脉瘤中，多发动脉瘤5例，夹层动脉瘤2例，假性动脉瘤3例，合并动静脉畸形（AVM）者11例，首次造影动脉瘤假阴性者2例。所有患者介入栓塞术均成功，其中单纯弹簧圈栓塞20例，Onyx/Glubran胶栓塞9例，弹簧圈加Onyx胶栓塞4例。微导管血管超选过程中诱发出血1例，拔除打胶导管出血1例，拔管困难1例。栓塞术中出血1例，遂行生物胶闭塞出血点后急诊开颅减压。术后小脑梗死6例，1例术后5 d行后颅凹开颅减压，1例术后意识变差，一侧肢体肌力下降，1例突发脑疝死亡，余3例患者无新增症状。脑干梗死1例，出现延髓麻痹及面瘫。合并AVM的患者中，同期栓塞5例，其中行弹簧圈闭塞AVM供血动脉者1例，二期栓塞AVM者1例，栓塞后开颅手术切除AVM者1例，1例动脉瘤合并幼稚型AVM，未予栓塞，选择随访，1例患者术后第2天突发脑疝死亡。所有动脉瘤栓塞术后即刻造影均显示动脉瘤完全闭塞。6个月造影复查28例，1例动脉瘤复发，余动脉瘤均不显影。临床随访30例，无新发神经功能缺损，改良Rankin量表评分0~2分者27例（90.0%），3~4分者3例（10%）。

介入栓塞治疗小脑后下动脉远端破裂性动脉瘤安全有效，但应根据动脉瘤具体特点选择栓塞材料。对合并小脑血管畸形者，大都可同期栓塞，但应根据畸形团的特点及其与动脉瘤关系选择治疗策略。

To analyze the safety and efficacy of interventional therapy for ruptured aneurysms of the distal posterior inferior cerebellar artery, and discuss the treatment strategies for the parent artery and accompanying vascular malformations.

The clinical data of 33 patients with hemorrhagic distal posterior inferior cerebellar artery aneurysm treated in the Department of Neurosurgery, Drum Tower Hospital, Nanjing University School of Medicine from January 2015 to March 2021 was collected. The patients were followed up upon 6 and 12 months postoperatively and received the cerebral angiography 6 months after the operation.

Thirty-three patients were confirmed with ruptured Distal-posterior inferior cerebellar artery (PICA) aneurysms. Among the 33 patients, 5 had multiple aneurysms at the distal end of PICA, 2 dissecting aneurysms, 3 pseudoaneurysms, 11 arteriovenous malformations (AVM), and 2 had a negative result by the first angiogram. Interventional embolization was successful in all patients，including 20 cases with coil embolization, 9 with Onyx/GLUBRAN biological glue, and 4 with coil plus Onyx. Bleeding was induced in 1 case during vascular superselection, another bleeding occurred when the catheter was removed. Extubation failed in 1 case with GLUBRAN embolization. One case had bleeding during embolization; hence, an emergency craniotomy was performed for decompression after hemostasis with Onyx embolization. There were 6 cases with cerebellar infarction after the operation: one case underwent decompression of the posterior fovea craniotomy 5 days after the operation; one case became mentally worse after the operation and limb muscle strength decreased; one case died of sudden brain herniation; and the remaining 3 cases did not have new symptoms. One case of brainstem infarction presented with bulbar palsy and facial paralysis. Among the patients with AVM, 5 cases were embolized simultaneously, of which, one case was treated by coil occlusion of the blood supply artery of AVM.1 case had secondary AVM embolization, and 2 cases had AVM resection after embolization. One case with naive AVM was not treated and was followed up. One patient died suddenly resulted from cerebral hernia. All aneurysms showed complete occlusion by angiography immediately after embolization. Upon 6 months, 28 cases were re-examined by angiography. One case of aneurysm recurred, and the rest of the aneurysms disappeared. Among the 30 cases of clinical follow-ups, no new neurological deficits were found. The modified Rankin Scale score was 0-2 in 27（90.0%）cases and 3-4 in 3 cases (10%).

Interventional embolization of distal PICA aneurysm is safe and effective, but the embolization material should be selected according to the specific characteristics of the aneurysm. Most patients with cerebellar vascular malformations can be embolized at the same time, but the strategy should be balanced according to the characteristics of the malformation and its relationship with the aneurysm.