Kim Jong-Hyun, Kwon Taek-Hyun, Kim Joo-Han, Park Youn-Kwan, Chung Hung-Seob
Department of Neurosurgery, College of Medicine, Korea University, Seoul 152-703, South Korea.
Surg Neurol. 2006 Oct;66(4):441-3; discussion 443. doi: 10.1016/j.surneu.2005.12.030. Epub 2006 Jul 21.
Aneurysms arising from nonbranching sites of the ICA, so-called dorsal wall aneurysm, are rare entity, and present as blister type or saccular type. Occasionally configurational changes have been observed on serial cerebral angiography: a small blister-like bulge on ICA wall on initial angiography progressing to a saccular appearance within a few weeks. Such aneurysm showing configurational change has been regarded as a false aneurysm with fragile wall just like blister-type aneurysm, and direct surgical approach has been considered highly risky.
A 42-year-old woman with a subarachnoid hemorrhage revealed small "blister-like" aneurysm at the medial wall of the ICA on initial angiography. After 12 days, the following angiograms demonstrated increased aneurysmal size and change of shape into a saccular configuration. Direct surgical approach was performed. The aneurysm had a relatively firm neck, and was successfully clipped without intraoperative rupture. The dome of aneurysm was resected after clipping and the histologic examination revealed it as a true aneurysm.
This case suggests that all dorsal wall aneurysms with configurational change are not false aneurysms, and that angiographic findings do not always correlate with the nature of the aneurysmal wall; therefore, we should give more credence to direct surgical observation rather than preoperative angiographic findings when considering the most suitable surgical option.
起源于颈内动脉非分支部位的动脉瘤，即所谓的后壁动脉瘤，是一种罕见的病变，表现为水泡型或囊状型。偶尔在系列脑血管造影中观察到形态变化：初始血管造影时颈内动脉壁上有一个小水泡样凸起，在几周内发展为囊状外观。这种显示形态变化的动脉瘤被认为是壁脆弱的假性动脉瘤，就像水泡型动脉瘤一样，直接手术入路被认为风险很高。
一名42岁蛛网膜下腔出血女性患者，初始血管造影显示颈内动脉内侧壁有小的“水泡样”动脉瘤。12天后，后续血管造影显示动脉瘤大小增加，形状变为囊状。进行了直接手术入路。动脉瘤颈部相对坚实，成功夹闭且术中未破裂。夹闭后切除动脉瘤瘤顶，组织学检查显示为真性动脉瘤。
该病例表明，并非所有形态改变的后壁动脉瘤都是假性动脉瘤，血管造影结果并不总是与动脉瘤壁的性质相关；因此，在考虑最合适的手术方案时，我们应更重视直接手术观察而非术前血管造影结果。
