Okamura Akitake, Kawamoto Yukihiko, Sakoda Eiichirou, Murakami Taro, Hara Takeshi, Okazaki Takahito, Kiura Yoshihiro, Kurisu Kaoru
Department of Neurosurgery, Hiroshima City Asa Hospital.
No Shinkei Geka. 2014 May;42(5):437-44.
Intracranial hemorrhage in patients with moyamoya disease is often caused by rupture of the associated aneurysms. Of these aneurysms, distal anterior choroidal artery (AChoA) aneurysms are rare. In patients with moyamoya disease, the AChoA constitutes collateral vessels and the aneurysm requires careful treatment strategy. However, reported cases of distal AChoA aneurysms include various procedures including conservative therapy, direct surgery, and endovascular therapy. Herein, we report a case of coil embolization of a distal AChoA aneurysm associated with moyamoya disease and discuss the treatment strategy. A 39-year-old female presented with severe headache and subsequent deep coma. Computed tomography (CT) revealed thick intraventricular hemorrhage, and three-dimensional CT angiography revealed a right distal AChoA aneurysm. Bilateral ventricular drainage was performed and subsequent ventriculoperitoneal (VP)shunt was performed. The persisting distal AChoA aneurysm was coil embolized without any complication. Rebleeding did not occur during the 1-year follow-up period. Endovascular treatment is effective for distal AChoA aneurysms associated with moyamoya disease to preserve collateral circulation.
烟雾病患者的颅内出血常由相关动脉瘤破裂引起。在这些动脉瘤中，脉络膜前动脉（AChoA）远端动脉瘤较为罕见。在烟雾病患者中，AChoA构成侧支血管，该动脉瘤需要谨慎的治疗策略。然而，已报道的AChoA远端动脉瘤病例包括多种治疗方法，如保守治疗、直接手术和血管内治疗。在此，我们报告一例与烟雾病相关的AChoA远端动脉瘤的弹簧圈栓塞病例，并讨论治疗策略。一名39岁女性出现严重头痛，随后陷入深度昏迷。计算机断层扫描（CT）显示脑室内大量出血，三维CT血管造影显示右侧AChoA远端动脉瘤。进行了双侧脑室引流，随后进行了脑室腹腔（VP）分流术。持续存在的AChoA远端动脉瘤进行了弹簧圈栓塞，未出现任何并发症。在1年的随访期内未发生再出血。血管内治疗对于与烟雾病相关的AChoA远端动脉瘤有效，可保留侧支循环。
