Clin Neuroradiol. 2011 Jun;21(2):87-90. doi: 10.1007/s00062-010-0038-1. Epub 2010 Dec 8.
An infrequent case of a de novo aneurysm formation originating from an infundibulum at the origin of the posterior communicating artery (PcomA) is presented. The aneurysm developed within 7 years in a patient who initially presented with subarachnoid hemorrhage (SAH) from a saccular aneurysm of the vertebral artery.
A 43-year-old female patient was admitted to our hospital on 16th June 2000 after an acute onset of massive occipital headache. A computed tomography (CT) scan showed a subarachnoid hemorrhage (SAH) around the brainstem and 4-vessel angiography revealed an aneurysm originating from the V4 segment of the right vertebral artery (VA) as the cause of the SAH. A small aneurysm at the basilar artery (BA)/superior cerebellar artery (SCA) bifurcation was also found. Injection of the left internal carotid artery (ICA) showed a diffuse enlargement at the origin of the left PcomA, which at this time was considered to be a so-called infundibulum. The VA aneurysm was treated by coil occlusion. Follow-up digital subtraction angiography (DSA) in 2005 showed a de novo aneurysm formation at the VA junction, again treated by coil occlusion. The PcomA infundibulum at the left ICA was not examined. Follow-up angiography performed in 2007 revealed a saccular de novo aneurysm of the left ICA arising from the origin of the left PcomA with a maximum diameter of 12 mm. Coil occlusion of the PcomA aneurysm was subsequently carried out.
Infundibular widening of cerebral arteries can develop into true aneurysms. Mid-term and long-term follow-up MRI (e.g., in yearly intervals) is advised for infundibula with a diameter of 3 mm or more. In patients with other aneurysm(s), with a documented de novo aneurysm formation or with a familial occurrence of aneurysms, the risk of evolution of an infundibulum to a saccular aneurysm may be increased and follow-up should be even more stringent.
本文报告了一例源自后交通动脉（PcomA）起始部漏斗状结构的新发动脉瘤。该动脉瘤在患者最初因椎动脉囊状动脉瘤破裂导致蛛网膜下腔出血（SAH）后 7 年内形成。
一名 43 岁女性患者于 2000 年 6 月 16 日因突发剧烈枕部头痛被收入我院。头颅 CT 扫描显示脑干周围蛛网膜下腔出血（SAH），4 血管造影显示右侧椎动脉（VA）V4 段起源处的动脉瘤是导致 SAH 的原因。基底动脉（BA）/小脑上动脉（SCA）分叉处还发现一个小的动脉瘤。左颈内动脉（ICA）造影显示左 PcomA 起始处弥漫性扩张，此时被认为是所谓的漏斗状结构。VA 动脉瘤采用线圈闭塞治疗。2005 年随访数字减影血管造影（DSA）显示 VA 交界处新发动脉瘤，再次采用线圈闭塞治疗。左侧 ICA 的 PcomA 漏斗状结构未检查。2007 年的随访血管造影显示起源于左侧 PcomA 的左侧颈内动脉新发囊状动脉瘤，最大直径 12mm。随后进行了 PcomA 动脉瘤的线圈闭塞治疗。
脑动脉漏斗状扩张可发展为真性动脉瘤。建议对直径 3mm 或以上的漏斗状结构进行中期和长期随访 MRI（例如每年随访一次）。对于有其他动脉瘤、已确诊新发动脉瘤形成或有家族性动脉瘤发生的患者，漏斗状结构演变为囊状动脉瘤的风险可能增加，应更加严格地随访。
