Haji Faizal Aminmohamed, Boulton Melfort R, de Ribaupierre Sandrine
Division of Neurosurgery, Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ont., Canada.
Pediatr Neurosurg. 2011;47(6):449-54. doi: 10.1159/000339355. Epub 2012 Jul 7.
With an incidence of less than 1-3 per million, pediatric aneurysms are rare clinical entities. A traumatic etiology is implicated in a large proportion of these cases, leading to the formation of both 'false' and 'true' aneurysms. These occur most often in the distal circulation, but have also been described in the supraclinoid distal internal carotid artery (ICA). Blood blister aneurysms are also found in this location; however, they have not been described in the pediatric population. We report the case of a 15-year-old male who presented following cranial trauma with diffuse basal subarachnoid hemorrhage and limited additional intracranial pathology. Computed tomography angiography demonstrated a small, 2-mm blister-like aneurysm arising from the dorsal surface of the left supraclinoid ICA at a non-branching site. Despite early endovascular treatment with Guglielmi detachable coils, the lesion continued to grow over subsequent studies, necessitating open surgical clipping. At the time of surgery, gross pathology of the native ICA was observed, raising the possibility of a preexisting blood-blister aneurysm. We review the epidemiology, pathophysiology and diagnostic considerations of these lesions. The endovascular and surgical management of these complex non-branching supraclinoid ICA aneurysms is also discussed.
小儿动脉瘤的发病率低于百万分之一至三，是罕见的临床病症。在这些病例中，很大一部分存在创伤性病因，可导致“假性”和“真性”动脉瘤的形成。这些动脉瘤最常发生在远端循环，但也有发生在床突上段颈内动脉（ICA）的报道。在此部位也可发现血泡样动脉瘤；然而，小儿人群中尚未见相关报道。我们报告一例15岁男性患者，因颅脑外伤后出现弥漫性基底池蛛网膜下腔出血，颅内其他病变有限。计算机断层血管造影显示在左侧床突上段ICA非分支部位的背侧有一个2毫米大小的小泡样动脉瘤。尽管早期采用 Guglielmi 可脱性弹簧圈进行了血管内治疗，但在后续检查中病变仍持续增大，因此需要进行开颅手术夹闭。手术时观察到了颈内动脉的大体病理情况，提示可能存在先前就有的血泡样动脉瘤。我们回顾了这些病变的流行病学、病理生理学和诊断要点。还讨论了这些复杂的床突上段ICA非分支动脉瘤的血管内和手术治疗方法。
