Patel Mira A, Caplan Justin M, Yang Wuyang, Colby Geoffrey P, Coon Alexander L, Tamargo Rafael J, Huang Judy
Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed Tower 6115F, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed Tower 6115F, Johns Hopkins Hospital, Baltimore, MD 21287, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Clin Neurosci. 2014 Dec;21(12):2184-8. doi: 10.1016/j.jocn.2014.07.005. Epub 2014 Aug 21.
Fenestrations of intracranial arteries and associated aneurysms are rare. The significance of these fenestrations in relation to aneurysms remains unclear. We present four patients with fenestration-associated aneurysms and a comprehensive review of associations with aneurysms and other vascular lesions. A PubMed search of the literature was conducted from 1970-2012 reporting cases of intracranial aneurysms associated with arterial fenestration or duplications. Data were collected on patient presentation, sex, age, aneurysm and fenestration location, aneurysm treatment, and presence of other vascular lesions. We performed a retrospective review of four patients with intracranial fenestrations associated with aneurysms at our institution from 2012-2013. There were 59 cases of fenestrations and associated aneurysms in the literature. Aneurysms were reported as either arising from (n=50) or adjacent to but distinct from (n=13) fenestrations. The most common single fenestration location was at the basilar artery (n=23, 36.5%); however the majority of fenestrations were in the carotid circulation (n=34, 54.0%). The majority of patients with aneurysms and fenestrations at all locations except those at the anterior communicating artery (70.5%) presented with subarachnoid hemorrhage. Patients with aneurysms arising from a fenestration or adjacent to a fenestration presented with an additional intracranial vascular lesion in 38% and 31% of cases, respectively. The majority of all aneurysms were treated with microsurgical clipping. Aneurysms associated with cerebral arterial fenestrations are most commonly discovered after subarachnoid hemorrhage and are most often located in the carotid circulation. A high index of suspicion must be maintained for an associated vascular lesion if an intracranial fenestration is discovered.
颅内动脉开窗及相关动脉瘤较为罕见。这些开窗与动脉瘤之间的关系尚不明确。我们报告了4例伴有开窗的动脉瘤患者，并对动脉瘤与其他血管病变的关联进行了全面综述。通过PubMed对1970年至2012年期间报道的颅内动脉瘤与动脉开窗或重复相关病例的文献进行了检索。收集了患者的临床表现、性别、年龄、动脉瘤及开窗位置、动脉瘤治疗情况以及其他血管病变的存在情况等数据。我们对2012年至2013年在本机构就诊的4例颅内开窗合并动脉瘤患者进行了回顾性研究。文献中共有59例开窗及相关动脉瘤病例。动脉瘤被报告为起源于开窗处（n = 50）或与开窗相邻但不同（n = 13）。最常见的单个开窗位置是在基底动脉（n = 23，36.5%）；然而，大多数开窗位于颈动脉循环（n = 34，54.0%）。除前交通动脉处的动脉瘤及开窗患者外（70.5%），其他所有位置的动脉瘤及开窗患者大多表现为蛛网膜下腔出血。起源于开窗处或与开窗相邻的动脉瘤患者，分别有38%和31%的病例伴有其他颅内血管病变。大多数动脉瘤采用显微手术夹闭治疗。与脑动脉开窗相关的动脉瘤最常在蛛网膜下腔出血后被发现，且最常位于颈动脉循环。如果发现颅内开窗，必须高度怀疑存在相关血管病变。
