Sugita Masao, Kinouchi Hiroyuki, Nishiyama Yoshihisa, Kanemaru Kazuya, Yoshioka Hideyuki, Horikoshi Toru
Department of Neurosurgery, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
Neurol Med Chir (Tokyo). 2009 Dec;49(12):600-3. doi: 10.2176/nmc.49.600.
A 75-year-old man was referred to our hospital with a thrombosed giant middle cerebral artery aneurysm manifesting as progressive memory disturbance and disorientation. Magnetic resonance imaging and conventional angiography revealed a partially thrombosed giant aneurysm of the left middle cerebral artery bifurcation and edema of the adjacent brain which had enlarged compared to 3 months before. Surgery was performed through a left frontotemporal craniotomy. After exposure of the aneurysm neck, we tried to apply a clip, which slipped due to the intraaneurysmal thrombus. Intraoperative motor evoked potential monitoring showed decreased amplitude. Therefore, the aneurysm dome was incised and the intraaneurysmal thrombus near the neck was shaved with the ultrasonic aspirator, followed by neck clipping of the aneurysm. The residual thrombus was safely removed. Transient right hemiparesis was observed after surgery, but his memory disturbance gradually improved. Giant thrombosed aneurysm can be treated by reduction of the thrombus from the far side to the lumen to reduce the duration of parent artery occlusion required for clipping.
一名75岁男性因大脑中动脉巨大血栓性动脉瘤导致进行性记忆障碍和定向障碍被转诊至我院。磁共振成像和传统血管造影显示左侧大脑中动脉分叉处有部分血栓形成的巨大动脉瘤，且与3个月前相比，相邻脑组织水肿加重。通过左侧额颞开颅手术进行治疗。暴露动脉瘤颈后，我们试图夹闭动脉瘤，但由于瘤内血栓，夹子滑脱。术中运动诱发电位监测显示波幅降低。因此，切开动脉瘤穹窿，用超声吸引器刮除颈部附近的瘤内血栓，随后夹闭动脉瘤颈部。残余血栓被安全清除。术后观察到短暂性右侧偏瘫，但他的记忆障碍逐渐改善。巨大血栓性动脉瘤可通过从远侧向管腔减少血栓来治疗，以缩短夹闭所需的母动脉闭塞时间。
