Kaku Yasuhiko, Yoshimura Shin-ichi, Sakai Noboru
Department of Neurosurgery, Gifu University School of Medicine, Tsukasamachi, Gifu, Japan.
Surg Neurol. 2004 Jun;61(6):546-50. doi: 10.1016/j.surneu.2003.07.003.
Carotid aneurysms of the paraclinoid segment are usually located in the intradural space, but can infrequently straddle the intra- and extradural space.
We present 2 cases of unruptured carotid dural ring aneurysms with an aneurysmal sac that straddled the distal dural ring. Each paraclinoid aneurysm projected superiorly from the anterior surface of the internal carotid artery with a relatively flattened dome and central indentation on angiography. The aneurysmal domes were circumscribed by the distal dural ring and straddled the intra- and extradural space. After broad opening of the distal dural ring, aneurysms were successfully obliterated by clip application in parallel with the internal carotid artery.
These cases underscore the significance of an aneurysmal dome indentation on angiographic images as a reflection of aneurysmal circumscription by the distal dural ring. Aneurysms that straddle the intra- and extradural space may require broad opening of the distal dural ring for adequate control and clipping.
床突旁段颈动脉瘤通常位于硬膜内间隙，但很少跨越硬膜内和硬膜外间隙。
我们报告2例未破裂的颈动脉硬膜环动脉瘤，其瘤囊跨越远端硬膜环。每个床突旁动脉瘤从颈内动脉前表面向上突出，在血管造影上瘤顶相对扁平且有中央凹陷。瘤顶被远端硬膜环包绕，跨越硬膜内和硬膜外间隙。在广泛打开远端硬膜环后，通过与颈内动脉平行夹闭成功闭塞动脉瘤。
这些病例强调血管造影图像上瘤顶凹陷作为远端硬膜环对动脉瘤包绕的反映的重要性。跨越硬膜内和硬膜外间隙的动脉瘤可能需要广泛打开远端硬膜环以进行充分控制和夹闭。
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