Abe Tomoyasu, Saito Nobuyuki, Kunishio Katuzo
Department of Neurosurgery, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo 164-8541, Japan.
No Shinkei Geka. 2008 Dec;36(12):1109-13.
A 56-year-old man presented with severe headache. Neurological examinations found no abnormalities and no disturbance of consciousness. CT revealed a subarachnoid hemorrhage. DSA showed an aneurysm located at the junction of the right internal carotid artery and the anterior choroidal artery. Next day, neck clipping was performed. The aneurysm adhered to the temporal lobe, and it seemed without doubt that it was a ruptured aneurysm. On day 10, we performed a carotid angiography on schedule. DSA revealed a newly arisen aneurysm originating from the middle cerebral artery close to the origin of the lenticulostriate artery and a vasospasm in the internal carotid artery and the middle cerebral artery. On day 14, we again performed surgery. The aneurysm was embedded in the insular cortex, but it seemed to be a non-ruptured aneurysm. After surgery, the patient had no apparent neurological deficits, and he returned to normal daily life. De novo aneurysms have been discovered after at least a few years. This case is very rare because the aneurysmal formation is of much a short interval.
一名56岁男性因严重头痛就诊。神经系统检查未发现异常,意识也无障碍。CT显示蛛网膜下腔出血。DSA显示一个动脉瘤位于右颈内动脉与脉络膜前动脉交界处。次日,进行了颈部夹闭术。动脉瘤与颞叶粘连,无疑是一个破裂的动脉瘤。在第10天,我们按计划进行了颈动脉血管造影。DSA显示一个新出现的动脉瘤起源于靠近豆纹动脉起始处的大脑中动脉,颈内动脉和大脑中动脉存在血管痉挛。在第14天,我们再次进行了手术。动脉瘤嵌入岛叶皮质,但似乎是一个未破裂的动脉瘤。手术后,患者没有明显的神经功能缺损,恢复了正常的日常生活。至少几年后发现了新生动脉瘤。该病例非常罕见,因为动脉瘤形成的间隔时间非常短。