Horie Nobutaka, Takahashi Nobuaki, Furuichi Shoji, Mori Katsuharu, Onizuka Masanari, Tsutsumi Keisuke, Shibata Shobu
Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan.
J Neurosurg. 2003 Aug;99(2):391-6. doi: 10.3171/jns.2003.99.2.0391.
Three cases of giant fusiform aneurysms in the middle cerebral artery (MCA) presenting with hemorrhages of different origins are reported, and appropriate literature is reviewed to investigate the characteristics of these lesions. Two patients had suffered a subarachnoid hemorrhage and the other had an intramural hemorrhage (dissection). Pathologically, these aneurysms presented with hemorrhages of different origins; classic rupture type (Case 1), dissection type (Case 2), and atherosclerosis-related thrombosis type (Case 3). Based on surgical and pathological investigations in these three cases and a review of the reported literature, the authors propose that giant fusiform aneurysms in the MCA are characterized by weaknesses in the internal elastic lamina with intimal thickening. Therefore, these lesions have the potential to present with hemorrhage in each of the three types. This finding indicates that there is a strong relationship between the pathological features of giant fusiform aneurysms and their clinical course, and that it is necessary to determine appropriate therapy for giant fusiform aneurysms in the MCA by evaluating cerebral blood flow, even if the lesions are found incidentally.
报告了3例大脑中动脉（MCA）巨大梭形动脉瘤，其出血来源各异，并回顾了相关文献以研究这些病变的特征。2例患者发生蛛网膜下腔出血，另1例发生壁内出血（夹层）。病理上，这些动脉瘤呈现出不同来源的出血；经典破裂型（病例1）、夹层型（病例2）和动脉粥样硬化相关血栓形成型（病例3）。基于这3例患者的手术和病理研究以及对已报道文献的回顾，作者提出MCA巨大梭形动脉瘤的特征是内弹性膜薄弱伴内膜增厚。因此，这些病变有可能出现这三种类型中的任何一种出血。这一发现表明，巨大梭形动脉瘤的病理特征与其临床病程之间存在密切关系，并且即使病变是偶然发现的，也有必要通过评估脑血流量来确定MCA巨大梭形动脉瘤的合适治疗方法。
