孤立性脊髓后動脈動脈瘤1例報告并文獻復習

【摘要】 目的 探討孤立性脊髓后動脈動脈瘤（IPSAA）的流行病學特征、發病機制、臨床表現、治療方式及預后。方法 回顧性分析南京醫科大學第一附屬醫院2021年9月收治的1例IPSAA患者的臨床資料，并復習相關文獻。結果 患者經對癥處理后癥狀緩解；2個月后脊柱MRI檢查顯示，Th3水平偏左側血管性病變。選擇性左側Th5肋間動脈造影示，Th3水平起源于脊髓后動脈的梭形動脈瘤，大小3.9 mm×2.1 mm；行顯微外科手術切除，患者出院時無神經功能缺失。 結論 IPSAA非常罕見，容易誤診，發病機制尚不明確；最常見的臨床癥狀為脊髓蛛網膜下腔出血，脊髓影像學檢查是其主要的確診方法；治療上首選顯微外科手術，療效確切。

【關鍵詞】 脊髓后動脈；脊髓動脈瘤；發病機制；診斷；治療

【中圖分類號】 R743" 【文獻標志碼】 B" 【文章編號】 1672-7770（2025）01-0114-03

Isolated posterior spinal artery aneurysm： report of 1 case and literature review

Abstract： Objective To explore the epidemiological features， pathogenesis， clinical manifestations， treatment strategies and prognosis of isolated posterior spinal artery aneurysm（IPSAA）. Methods The clinical data of a patient with IPSAA admitted to the First Affiliated Hospital of Nanjing Medical University in September 2021 was analyzed retrospectively and the relevant literature were reviewed." Results The symptoms were relieved after symptomatic treatment. Two months later， spinal magnetic resonance imaging （MRI） showed a lesion on the left side of the spinal cord at Th3 level. Selective left Th5 intercostal artery angiography showed a 3.9 mm×2.1 mm fusiform aneurysm involving the radiculopial artery at Th3 level. Microsurgical resection was performed， and the patient was discharged without neurological deficits." Conclusions IPSAAs are extremely rare and easy to be misdiagnosed as other diseases. The pathogenesis is not very clear. The most common clinical presentation is spinal subarachnoid hemorrhage and spinal imaging examinations are the main methods for diagnosis. Microsurgery is the first choice for treatment and the curative effect is definite.

Key words： posterior spinal artery; spinal aneurysm; pathogenesis; diagnosis; treatment

孤立性脊髓后動脈動脈瘤（isolated posterior spinal artery aneurysm，IPSAA）臨床較為罕見，發病機制尚未完全明確。其主要臨床表現是脊髓蛛網膜下腔出血（subarachnoid hemorrhage，SAH）引起的相關癥狀與體征，因出血節段不同，癥狀與體征亦不相同，容易誤診為其他疾病或漏診，延誤治療時機，導致不良預后［1］。本研究回顧性分析南京醫科大學第一附屬醫院2021年9月收治的1例IPSAA患者的臨床資料，并結合相關文獻復習，旨在探討IPSAA患者的流行病學特征、發病機制、臨床表現、治療方式及預后，以期提高對該疾病的認識和診療水""" 平。現報告如下。

1 臨床資料

患者女，53歲，因“突發上背部疼痛、嘔吐及雙下肢無力兩月余”于2019年9月入院。患者2個月前在重體力勞動后突發上背部疼痛……