Cho Jae Ik, Cho Jae Hoon
Department of Neurosurgery, Cheju Halla Hospital, Jeju, Korea.
Department of Neurosurgery, Daegu Catholic University Hospital, Daegu, Korea.
J Korean Neurosurg Soc. 2014 Dec;56(6):496-9. doi: 10.3340/jkns.2014.56.6.496. Epub 2014 Dec 31.
Owing to the focal wall defect covered with thin fibrous tissues, an aneurysm arising from the dorsal wall of the internal carotid artery (ICA) is difficult to manage either surgically or endovascularly and is often associated with high morbidity and mortality. Unfortunately, the definitive treatment modality of such highly risky aneurysm has not yet been demonstrated. Upon encountering the complex intracranial pathophysiology of such a highly precarious aneurysm, a neurosurgeon would be faced with a challenge to decide on an optimal approach. This is a case of multiple paraclinoid aneurysms including the ICA dorsal wall aneurysm, presented with spontaneous subarachnoid hemorrhage. With respect to treatment, direct clipping with a Sundt graft clip was performed after multiple endovascular interventions had failed. This surgical approach can be a treatment modality for a blood blister-like aneurysm after failed endovascular intervention(s).
由于病灶壁缺损被薄纤维组织覆盖，起源于颈内动脉（ICA）后壁的动脉瘤无论是手术治疗还是血管内治疗都很难处理，且常伴有高发病率和死亡率。不幸的是，这种高风险动脉瘤的确定性治疗方式尚未得到证实。当遇到这种极其危险的动脉瘤复杂的颅内病理生理情况时，神经外科医生在决定最佳治疗方法时会面临挑战。这是一例包括ICA后壁动脉瘤在内的多个床突旁动脉瘤病例，表现为自发性蛛网膜下腔出血。在多次血管内干预失败后，采用Sundt移植夹进行直接夹闭治疗。这种手术方法可以作为血管内干预失败后血泡样动脉瘤的一种治疗方式。
