Sadahiro Hirokazu, Shimizu Hiroaki, Inoue Takashi, Tominaga Teiji
Department of Neurosurgery, Kohnan Hospital, Japan.
No Shinkei Geka. 2009 Mar;37(3):269-75.
Surgical treatment of large cerebral aneurysms may depend on preoperative information regarding the wall thickness and the intraaneurysmal thrombosis. When the neck of an aneurysm is thick due to atherosclerosis or there is a marked thrombosis inside the aneurysm, clipping may not be possible. Here we report three cases with large internal carotid artery aneurysms that were evaluated for the thickness of the aneurysm wall and the presence of thrombosis by 3 tesla magnetic resonance (MR) imaging. A high-resolution T2-weighted imaging (HRT2WI) modified for 3 tesla was used. In two cases, the images showed the thickened wall of the dome to some extent which apparently did not reach the neck. These aneurysms were successfully neck clipped. The third patient showed marked thickening of the wall, which may be associated with thrombosis, which extended to the neck. Intraoperative findings of the aneurysm wall were compatible with these factors, and removal of atherosclerotic plaque and thrombus from the neck and dome of the aneurysm was necessary before successful neck clipping. The HRT2WI may contribute to a better surgical strategy for large aneurysms which may have wall thickening.
大脑大型动脉瘤的手术治疗可能取决于术前有关动脉瘤壁厚度和瘤内血栓形成的信息。当动脉瘤颈部因动脉粥样硬化而增厚，或者动脉瘤内存在明显血栓形成时，可能无法进行夹闭术。在此，我们报告3例大脑中大型颈内动脉瘤病例，通过3特斯拉磁共振（MR）成像评估动脉瘤壁厚度和血栓形成情况。采用了针对3特斯拉改进的高分辨率T2加权成像（HRT2WI）。在2例病例中，图像显示瘤顶壁有一定程度增厚，但显然未延伸至颈部。这些动脉瘤成功进行了颈部夹闭术。第3例患者显示瘤壁明显增厚，可能与血栓形成有关，且血栓延伸至颈部。动脉瘤壁的术中发现与这些因素相符，在成功进行颈部夹闭术之前，有必要从动脉瘤颈部和瘤顶清除动脉粥样硬化斑块和血栓。HRT2WI可能有助于为可能存在瘤壁增厚的大型动脉瘤制定更好的手术策略。
