大脑后动脉完整环合并脉络膜后内侧动脉起始处动脉瘤破裂。病例报告。
Complete loop of the posterior cerebral artery with ruptured aneurysm at the origin of the medial posterior choroidal artery. A case report.
作者信息
Muzii Vitaliano F, Dashti Reza, Toninelli Stefano, Hernesniemi Juha
机构信息
Section of Neurosurgery, Department of Neurological, Neurosurgical and Behavioural Sciences, University of Siena, 53100 Siena, Italy.
出版信息
Surg Neurol. 2009 Oct;72(4):403-5. doi: 10.1016/j.surneu.2008.08.001. Epub 2009 Jan 14.
BACKGROUND
Anatomical anomalies of the PCA are unusual and their association with an aneurysm is exceptional. A unique case of a complete loop of the posterior cerebral artery associated with a ruptured aneurysm is presented.
CASE DESCRIPTION
A 69-year-old woman with a subarachnoid hemorrhage in World Federation of Neurosurgical Societies grade IV was diagnosed with a loop of the right PCA with an aneurysm at the apex of the loop. At surgery, the aneurysm was found to arise at the origin of the MPChA and it was clipped. Three months later, after improving to Glasgow Outcome Scale 3, the patient died of unrelated cause.
CONCLUSIONS
To our knowledge, a complete loop of the PCA associated with an aneurysm at the origin of the MPChA has never been described. Microneurosurgical approach via subtemporal craniotomy was safe and effective in displaying the anomalous anatomy and allowing perfect clipping of the aneurysm.
背景
大脑后动脉（PCA）的解剖异常并不常见，且其与动脉瘤相关的情况极为罕见。本文报告了一例独特的病例，即大脑后动脉完全成环并伴有破裂动脉瘤。
病例描述
一名69岁女性，世界神经外科联合会（WFNS）分级为IV级蛛网膜下腔出血，诊断为右侧大脑后动脉成环，环的顶端有一个动脉瘤。手术中发现动脉瘤起源于脉络膜后动脉内侧支（MPChA）的起始处，并进行了夹闭。三个月后，患者恢复到格拉斯哥预后评分3级，但死于无关原因。
结论
据我们所知，从未有过关于MPChA起始处伴有动脉瘤的大脑后动脉完全成环的描述。经颞下入路的显微神经外科手术在显示异常解剖结构和实现动脉瘤完美夹闭方面是安全有效的。
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