Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan.
Neurosurgery. 2011 Oct;69(4):E1005-8; discussion E1009. doi: 10.1227/NEU.0b013e318223b613.
We present a rare case of fenestration of the left supraclinoid intracranial internal carotid artery with 2 associated aneurysms arising proximally and distally from the fenestration that were successfully treated with endovascular coil embolization. This is the first report of these types of aneurysms treated with coiling alone.
A 47-year-old woman underwent a diagnostic workup; magnetic resonance angiography incidentally revealed 2 tandem aneurysms at the supraclinoid and paraclinoid portion of the left internal carotid artery. Angiography revealed fenestration of the left supraclinoid internal carotid artery with 2 aneurysms both proximal and distal to the fenestration. The patient underwent endovascular coil embolization of the aneurysms simultaneously. The smaller trunk was intentionally occluded to achieve complete packing of the proximal aneurysm. Both aneurysms were totally occluded, and no neurological deficits developed in the patient.
Based on previous reports, fenestration has the potential to form an aneurysm, and there seemed to be a relatively high incidence of rupture if accompanied by aneurysm. Coiling is one good option to treat aneurysms and should be considered when multiple aneurysms exist because all aneurysms can be treated simultaneously. Proximal occlusion of the smaller trunk is acceptable because of a retrograde flow from the distal end, even if one exists.
我们报告了一例罕见的左颈内动脉岩骨段开窗伴 2 个近端和远端起源于开窗的动脉瘤的病例，通过血管内线圈栓塞成功治疗。这是首例单独采用线圈治疗这些类型动脉瘤的报道。
一名 47 岁女性进行了诊断性检查；磁共振血管造影意外发现左颈内动脉岩骨段和近岩骨段有 2 个串联动脉瘤。血管造影显示左颈内动脉岩骨段开窗，开窗近端和远端各有 1 个动脉瘤。患者同时接受了动脉瘤的血管内线圈栓塞治疗。较小的主干被故意闭塞，以实现近端动脉瘤的完全填塞。2 个动脉瘤均完全闭塞，患者未出现神经功能缺损。
根据以往的报告，开窗有形成动脉瘤的潜力，如果伴有动脉瘤，破裂的风险似乎相对较高。线圈栓塞是治疗动脉瘤的一种较好选择，如果存在多个动脉瘤，应考虑同时治疗，因为可以同时处理所有动脉瘤。即使存在较小的主干逆行血流，近端闭塞较小的主干也是可以接受的。
