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双侧颈内动脉闭塞患者丘脑前穿动脉破裂动脉瘤的胶水栓塞术

Glue embolization of ruptured anterior thalamoperforating artery aneurysm in patient with both internal carotid arteries occlusion.

作者信息

Lee Jae Il, Choi Chang Hwa, Ko Jun Kyeung, Lee Tae Hong

机构信息

Department of Neurosurgery, School of Medicine, Pusan National University Hospital, Busan, Korea.

出版信息

J Korean Neurosurg Soc. 2011 May;49(5):287-9. doi: 10.3340/jkns.2011.49.5.287. Epub 2011 May 31.

Abstract

Thalamoperforating artery aneurysms are rarely reported in the literature. We report an extremely rare case of ruptured distal anterior thalamoperforating artery aneurysm which was treated by endovascular obliteration in a patient with occlusion of both the internal carotid arteries (ICAs) : A 72-year-old woman presented with severe headache and loss of consciousness. Initial level of consciousness at the time of admission was drowsy and the Glasgow Coma Scale score was 14. Brain computed tomography (CT) scan was performed which revealed intracerebral hemorrhage in right basal ganglia, subarachnoid hemorrhage, and intraventricular hemorrhage. The location of the aneurysm was identified as within the globus pallidus on CT angiogram. Conventional cerebral angiogram demonstrated occlusion of both the ICAs just distal to the fetal type of posterior communicating artery and the aneurysm was arising from right anterior thalamoperforating artery (ATPA). A microcatheter was navigated into ATPA and the ATPA proximal to aneurysm was embolized with 20% glue. Post-procedural ICA angiogram demonstrated no contrast filling of the aneurysm sac. The patient was discharged without any neurologic deficit. Endovascular treatment of ATPA aneurysm is probably a more feasible and safe treatment modality than surgical clipping because of the deep seated location of aneurysm and the possibility of brain retraction injury during surgical operation.

摘要

丘脑穿通动脉动脉瘤在文献中鲜有报道。我们报告了一例极其罕见的远端丘脑前穿通动脉动脉瘤破裂病例,该病例在双侧颈内动脉闭塞的患者中通过血管内栓塞治疗:一名72岁女性出现严重头痛和意识丧失。入院时初始意识状态为嗜睡,格拉斯哥昏迷量表评分为14分。进行了脑部计算机断层扫描(CT),显示右侧基底节区脑出血、蛛网膜下腔出血和脑室内出血。CT血管造影显示动脉瘤位于苍白球内。传统脑血管造影显示双侧颈内动脉在胎儿型后交通动脉远端闭塞,动脉瘤起源于右侧丘脑前穿通动脉(ATPA)。将微导管插入ATPA,用20%的胶水栓塞动脉瘤近端的ATPA。术后颈内动脉血管造影显示动脉瘤囊无造影剂充盈。患者出院时无任何神经功能缺损。由于动脉瘤位置深以及手术过程中可能出现脑牵拉损伤,丘脑前穿通动脉动脉瘤的血管内治疗可能比手术夹闭更可行、更安全。

相似文献

本文引用的文献

1
Development of 'De novo' Aneurysm after Therapeutic Carotid Occlusion.治疗性颈动脉闭塞后“新生”动脉瘤的发生
J Korean Neurosurg Soc. 2009 Apr;45(4):236-9. doi: 10.3340/jkns.2009.45.4.236. Epub 2009 Apr 30.

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