Inoue Akihiro, Kohno Kanehisa, Takeda Tetsuji, Takechi Akihiko, Kohno Keiji, Yamaguchi Yoshiaki, Ishii Daizo, Sasaki Ushio
Department of Neurosurgery, Ehime Prefectural Central Hospital, Japan.
No Shinkei Geka. 2006 Nov;34(11):1131-8.
We report 2 cases of multiple aneurysms (AN) associated with main trunk artery occlusion. CASE 1: A 52-year-old male was admitted to our hospital with dysarthria and weakness of the right side of the body. Computed tomography (CT) showed cerebral infarction in the left corona radiata. MR angiography and conventional angiography showed occlusion of the left middle cerebral artery (MCA) and saccular aneurysms (ANs) at the origin of the anterior communicating artery (A-com) and bifurcation of the right MCA. Subsequent 123I-IMP-single photon emission tomography (SPECT) revealed marked reduction of cerebral blood flow and disturbed reactivity to acetazolamide in the left cerebral hemisphere. Superficial temporal artery (STA)-MCA anastomosis was performed to improve cerebral blood flow and reduce hemodynamic stress for AN of the A-com and right MCA. At 5 months after the first operation, neck clipping was performed successfully for the non-ruptured A-com AN and right MCA AN. CASE 2: A 65-year-old male was admitted to our hospital. CT revealed subarachnoid hemorrhage (SAH), and 3D-computed tomographic angiography (CTA) and cerebral angiography showed basilar top AN, A-com AN and right MCA AN associated with right internal carotid artery occlusion. Right ACA and MCA territories were visualized from the A-com artery and posterior cerebral artery. STA-MCA anastomosis was performed to improve cerebral blood flow and reduce hemodynamic stress for ANs. In the same operation, successful neck clipping was performed for BA top AN and right MCA AN. In such cases as these, particularly in ischemic cases associated with main trunk artery occlusion, it was important to consider surgery for AN after STA-MCA anastomosis in anticipation of improved cerebral blood flow and reduce hemodynamic stress for AN.
我们报告2例与主干动脉闭塞相关的多发性动脉瘤(AN)。病例1:一名52岁男性因构音障碍和身体右侧无力入院。计算机断层扫描(CT)显示左侧放射冠脑梗死。磁共振血管造影和传统血管造影显示左侧大脑中动脉(MCA)闭塞,前交通动脉(A-com)起始处和右侧MCA分叉处有囊状动脉瘤(ANs)。随后的123I-异碘普胺单光子发射断层扫描(SPECT)显示左侧大脑半球脑血流量显著减少,对乙酰唑胺的反应性受损。进行了颞浅动脉(STA)-MCA吻合术以改善脑血流量,并减轻A-com和右侧MCA动脉瘤的血流动力学压力。首次手术后5个月,成功对未破裂的A-com动脉瘤和右侧MCA动脉瘤进行了瘤颈夹闭术。病例2:一名65岁男性入院。CT显示蛛网膜下腔出血(SAH),三维计算机断层血管造影(CTA)和脑血管造影显示基底动脉尖部动脉瘤、A-com动脉瘤和右侧MCA动脉瘤,伴有右侧颈内动脉闭塞。右侧ACA和MCA区域可通过A-com动脉和大脑后动脉显影。进行了STA-MCA吻合术以改善脑血流量,并减轻动脉瘤的血流动力学压力。在同一手术中,成功对基底动脉尖部动脉瘤和右侧MCA动脉瘤进行了瘤颈夹闭术。在这些病例中,特别是在与主干动脉闭塞相关的缺血性病例中,在STA-MCA吻合术后考虑对动脉瘤进行手术很重要,以期改善脑血流量并减轻动脉瘤的血流动力学压力。