Hongo K, Morota N, Watabe T, Isobe M, Nakagawa H
Department of Neurological Surgery, Aichi Medical University, Nagakute, Aichi, Japan.
J Clin Neurosci. 2001 Jan;8(1):51-4. doi: 10.1054/jocn.2000.0730.
We report a rare case of a non-ruptured basilar bifurcation aneurysm presenting as a third ventricular mass producing unilateral obstructive hydrocephalus. This is the first reported case of its kind. A 70 year old woman presented with a giant basilar bifurcation aneurysm in which the aneurysm protruded into the third ventricle as a mass causing unilateral left hydrocephalus. The patient gradually became disoriented and developed a right hemiparesis and global aphasia. The right vertebral artery was occluded by placing coils intravascularly followed by an endoscopic septostomy. The patient's neurological state dramatically improved immediately. One month after the septostomy, however, the aneurysm ruptured and the patient eventually died. Treatment of the hydrocephalus only was selected instead of direct surgery or an intravascular procedure on the aneurysm, which eventually ruptured. The mechanisms for the unilateral hydrocephalus and the rupture of the aneurysm are described. The treatment strategy for these lesions is also discussed.
我们报告一例罕见的未破裂基底动脉分叉部动脉瘤，表现为第三脑室内肿块并导致单侧梗阻性脑积水。这是首例此类报道病例。一名70岁女性患者，患有巨大基底动脉分叉部动脉瘤，动脉瘤作为肿块突入第三脑室，导致左侧单侧脑积水。患者逐渐出现定向障碍，并发展为右侧偏瘫和完全性失语。通过血管内放置弹簧圈栓塞右侧椎动脉，随后进行内镜下造瘘术。患者的神经状态立即显著改善。然而，造瘘术后一个月，动脉瘤破裂，患者最终死亡。选择仅治疗脑积水而非对动脉瘤进行直接手术或血管内治疗，而动脉瘤最终破裂。本文描述了单侧脑积水和动脉瘤破裂的机制。还讨论了这些病变的治疗策略。
