Kawashima Akitsugu, Okada Yoshikazu, Kawamata Takakazu, Onda Hideaki, Kubo Osami, Hori Tomokatsu
Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
J Clin Neurosci. 2008 Jul;15(7):797-800. doi: 10.1016/j.jocn.2007.03.012. Epub 2008 Apr 10.
Treatment of blood blister-like aneurysms of the internal carotid artery (ICA) is difficult because the wall of the aneurysm is fragile and there is a high risk of rebleeding. There has been no consensus on the best way to treat these aneurysms. A 32-year-old woman presented with subarachnoid hemorrhage (SAH) caused by a ruptured blood blister-like aneurysm of the ICA. The site of the aneursym was clipped. Although angiography 1week after the operation showed that the aneurysm had been treated successfully, 3 weeks after the initial operation, the aneurysm was found to have recurred to the distal side. In a second operation, the aneurysm was successfully treated by trapping with a high-flow bypass. This case shows that clipping of the rupture site can be insufficient to treat blood blister-like aneurysm of the ICA causing SAH, even if the aneurysm seems to have resolved in follow-up angiographic studies. Trapping of the ICA with a bypass, if necessary a high-flow bypass, is recommended.
治疗颈内动脉血泡样动脉瘤很困难，因为动脉瘤壁很脆弱，再出血风险很高。对于治疗这些动脉瘤的最佳方法尚无共识。一名32岁女性因颈内动脉血泡样动脉瘤破裂导致蛛网膜下腔出血（SAH）就诊。对动脉瘤部位进行了夹闭。尽管术后1周血管造影显示动脉瘤已成功治疗，但在初次手术后3周，发现动脉瘤在远端复发。在第二次手术中，通过高流量搭桥术进行包裹成功治疗了动脉瘤。该病例表明，即使在随访血管造影研究中动脉瘤似乎已消失，但夹闭破裂部位可能不足以治疗导致SAH的颈内动脉血泡样动脉瘤。如有必要，建议采用高流量搭桥术对颈内动脉进行包裹。
