Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
World Neurosurg. 2013 May-Jun;79(5-6):798.E7-11. doi: 10.1016/j.wneu.2012.07.031. Epub 2012 Aug 11.
Mycotic aneurysm rupture has been described as a rare, universally fatal complication of central nervous system Coccidioides immitis meningitis. Recently, however, we reported the successful surgical management of a midbasilar dissecting mycotic aneurysm related to C. immitis meningitis in a 24-year-old pregnant woman with acquired immune deficiency syndrome.
A 24-year-old pregnant woman with known acquired immune deficiency syndrome and a history of C. immitis meningitis presented to our institution with subarachnoid and intraventricular hemorrhage. Diagnostic cerebral angiography revealed a dissecting, midbasilar aneurysm involving the right anterior inferior cerebellar artery and causing stenosis of the proximal basilar artery. Through a retrosigmoid craniotomy, clip reconstruction of the basilar artery under hypothermic circulatory arrest was performed. The patient was neurologically intact at discharge (postoperative day 19) with the exception of mild disconjugate gaze and headache.
At her 53-month follow-up, the patient was neurologically intact with only mild disconjugate gaze on upgaze. There was no evidence of local aneurysm recurrence or regional aneurysm formation, and the basilar artery was patent. Her C. immitis meningitis was well controlled. The patient is maintained on oral highly active antiretroviral therapy and an antifungal regimen.
Our patient represents the only survivor of a C. immitis mycotic aneurysm rupture. In her case, long-term clinical and radiographic stability were achieved through a vigilant multidisciplinary approach.
真菌性动脉瘤破裂被描述为中枢神经系统新型隐球菌脑膜炎的一种罕见的、普遍致命的并发症。然而，最近我们报道了一例成功的手术治疗 24 岁艾滋病合并新型隐球菌性脑膜炎相关基底动脉中段夹层真菌性动脉瘤的病例。
一名 24 岁的孕妇，患有获得性免疫缺陷综合征和新型隐球菌性脑膜炎病史，因蛛网膜下腔和脑室出血就诊于我院。诊断性脑血管造影显示基底动脉中段夹层动脉瘤，累及右侧小脑前下动脉，导致基底动脉近端狭窄。通过枕下乙状窦后入路，在低温循环阻断下进行基底动脉夹闭重建。患者术后第 19 天（出院日）神经功能完整，仅存在轻度的分离性眼球运动障碍和头痛。
53 个月随访时，患者神经功能完整，仅在上视时存在轻度分离性眼球运动障碍。无局部动脉瘤复发或区域性动脉瘤形成的证据，基底动脉通畅。患者的新型隐球菌性脑膜炎得到很好的控制。目前患者接受口服高效抗逆转录病毒治疗和抗真菌治疗。
我们的患者是新型隐球菌性动脉瘤破裂的唯一幸存者。通过多学科的密切监测和治疗，患者获得了长期的临床和影像学稳定。
