Duke University Medical Center, Durham, North Carolina, USA.
J Neurointerv Surg. 2010 Sep;2(3):213-6. doi: 10.1136/jnis.2009.001883. Epub 2010 Jun 15.
Giant fusiform aneurysms of the middle cerebral artery (MCA) bifurcation pose significant treatment challenges. A giant fusiform aneurysm of the left MCA in a pediatric patient, which persisted despite Hunterian ligation of the M1 and double barrel superficial temporal artery (STA) to M2 bypasses, is reported. The aneurysm was trapped by endovascular coiling of the feeding M2 trunk through the STA anastamosis. Hunterian ligation combined with extracranial-intracranial bypass is an effective technique for treating giant fusiform aneurysms of the MCA bifurcation for patients who fail balloon test occlusions. However, in certain cases, flow reversal may not eliminate the aneurysm and continued aneurysm filling may occur through retrograde filling from the bypass recipient vessels. In these cases, endovascular trapping of the aneurysm may be undertaken through the bypass graft. The feasibility of this management scheme is demonstrated.
大脑中动脉（MCA）分叉处的巨大梭形动脉瘤带来了重大的治疗挑战。报告了一例左侧 MCA 巨大梭形动脉瘤患儿，尽管进行了 M1 夹闭和双筒颞浅动脉（STA）到 M2 旁路的双重 STA 旁路术，但动脉瘤仍持续存在。通过经 STA 吻合口对供血的 M2 干进行血管内线圈栓塞来夹闭动脉瘤。对于球囊闭塞试验失败的 MCA 分叉处巨大梭形动脉瘤患者，Hunterian 结扎联合颅内外旁路是一种有效的治疗技术。然而，在某些情况下，血流逆转可能无法消除动脉瘤，并且可能通过旁路受者血管的逆行填充继续填充动脉瘤。在这些情况下，通过旁路移植物进行动脉瘤的血管内夹闭是可行的。该治疗方案的可行性得到了证实。
