Alaraj Ali, Behbahani Mandana, Valyi-Nagy Tibor, Aardsma Nathan, Aletich Victor A
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
BMJ Case Rep. 2014 Apr 19;2014:bcr2014011192. doi: 10.1136/bcr-2014-011192.
A middle-aged patient presented with a rapidly growing right dural-based extra-axial posterior clinoid mass extending to the right cavernous sinus that was surgically resected. Histological examination showed solid growth of primitive neuroectodermal tumor arising from the third nerve. Following surgical resection, the patient was further managed by radiation and chemotherapy. Two years later the patient developed new intracranial hemorrhage in the area adjacent to the previous surgical cavity. A cerebral angiogram showed contrast extravasation at the junction of the posterior communicating artery (Pcom) and the right posterior cerebral artery (PCA), with an expanding pseudoaneurysm. This was managed with N-butyl cyanoacrylate embolization. Autopsy showed microscopic recurrence of tumor into the PCA/PCom region with invasion of the wall of the Pcom. This case report illustrates the concept of vascular blowout in intracranial cerebral vasculature. It appears that, in the presence of risk factors that contribute to weakening of vessel walls (surgery, radiation, tumor recurrence), a blowout can occur intracranially.
一名中年患者出现一个迅速生长的、位于右侧硬脑膜的轴外后床突肿块，延伸至右侧海绵窦，该肿块接受了手术切除。组织学检查显示起源于第三神经的原始神经外胚层肿瘤呈实体性生长。手术切除后，患者进一步接受放疗和化疗。两年后，患者在先前手术腔附近区域出现新的颅内出血。脑血管造影显示在后交通动脉（Pcom）与右侧大脑后动脉（PCA）交界处有造影剂外渗，伴有一个不断扩大的假性动脉瘤。对此采用氰基丙烯酸正丁酯栓塞治疗。尸检显示肿瘤在显微镜下复发至PCA/PCom区域，并侵犯了Pcom壁。本病例报告阐述了颅内脑血管系统中血管破裂的概念。似乎在存在导致血管壁薄弱的危险因素（手术、放疗、肿瘤复发）时，颅内可能会发生血管破裂。
