Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
World Neurosurg. 2014 Feb;81(2):441.e1-7. doi: 10.1016/j.wneu.2012.12.006. Epub 2012 Dec 12.
Intracranial arterial dissection is an uncommon but well-recognized entity. Treatment remains variable, ranging from observation to intervention via the use of either surgical or endovascular techniques. Aneurysms along the lenticulostriate artery have been reported in only 41 patients. With the current case study we illustrate the effectiveness of observation in the context of a dissecting lenticulostriate aneurysm and discuss other approaches that have been used in the treatment of this particular entity.
An accomplished mountain climber presented, after coitus, with acute headache, mild facial weakness, and forgetfulness. Vascular imaging studies revealed a right putaminal hemorrhage secondary to a 3-mm lenticulostriate artery dissecting aneurysm. Clinically, the patient did well, with marked improvement in presenting symptoms enabling his return to mountain climbing. Follow-up angiography showed spontaneous resolution of the arterial dissecting aneurysm. Among the 41 reported cases, 19 were idiopathic, 5 associated with hypertension, and 17 related to various conditions such as Moyamoya disease, arteriovenous malformation, systemic vasculitis, intraventricular tumor, or substance abuse. Of the 42 cases, including the present case, 28 were surgically or endovascularly managed and 12 observed. Only one of the reported cases, a 33-year-old man with Moyamoya disease, who was managed conservatively, died of rebleeding.
There is no common consensus in the literature on a single treatment strategy for a lenticulostriate artery aneurysm. The present case illustrates that observation and follow-up vascular imaging can be an important treatment strategy, allowing healing of the vessel wall and disappearance of the dissecting aneurysm.
颅内动脉夹层是一种不常见但已被充分认识到的疾病。治疗方法多种多样，从观察到介入治疗，包括手术或血管内技术。仅有 41 例患者报告了纹状体动脉分支的动脉瘤。通过本病例研究，我们展示了观察在夹层纹状体动脉动脉瘤中的有效性，并讨论了其他已用于治疗这种特殊疾病的方法。
一位经验丰富的登山者在性行为后出现急性头痛、轻度面部无力和健忘。血管成像研究显示右侧豆纹动脉 3 毫米夹层动脉瘤引起的出血。临床方面，患者表现良好，主要症状明显改善，能够恢复登山活动。随访血管造影显示动脉夹层动脉瘤自发缓解。在报告的 41 例病例中，19 例为特发性，5 例与高血压有关，17 例与各种情况有关，如烟雾病、动静脉畸形、系统性血管炎、脑室内肿瘤或药物滥用。包括本病例在内的 42 例中，28 例采用手术或血管内治疗，12 例采用观察治疗。报告的病例中只有 1 例，一位 33 岁的烟雾病患者，保守治疗，死于再出血。
对于纹状体动脉动脉瘤，文献中没有关于单一治疗策略的共识。本病例表明，观察和随访血管成像可以是一种重要的治疗策略，允许血管壁愈合和夹层动脉瘤消失。
