Kochi Ryuzaburo, Endo Hidenori, Fujimura Miki, Sato Kenichi, Sugiyama Shin-ichiro, Osawa Shin-ichiro, Tominaga Teiji
Department of Neurosurgery, Kohnan Hospital, Sendai, Japan; Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
J Stroke Cerebrovasc Dis. 2015 Aug;24(8):e223-6. doi: 10.1016/j.jstrokecerebrovasdis.2015.04.020. Epub 2015 Jun 5.
Surgical treatments should be considered for vertebral artery fusiform aneurysms, which become symptomatic due to cerebral ischemia or mass effect. Ischemic complication is one of the major problems after surgical or endovascular trapping, which is associated with unfavorable outcomes. The authors present a case with growing vertebral artery (VA) fusiform aneurysm with ischemic onset successfully treated with outflow occlusion with occipital artery-posterior inferior cerebellar artery (OA-PICA) bypass. A 50-year-old woman presented with left PICA territory infarction. Left vertebral angiography (VAG) showed occlusion of the left VA at the proximal V4 segment. Right VAG revealed that the distal part of the left V4 segment with fusiform aneurysmal dilatation was reconstituted through vertebrobasilar junction, and the left PICA was the outlet of the blood flow from the fusiform aneurysm. Although the patient was treated conservatively, enlargement of the left VA fusiform aneurysm was observed 8 months after the initial presentation. Considering the potential risks for future stroke or bleeding, we performed clip occlusion of the origin of the left PICA, which could achieve outflow occlusion of the fusiform aneurysm with preservation of the perforators arising around the aneurysm. We created OA-PICA anastomosis for revascularization of the distal PICA. The postoperative course was uneventful, and the postoperative right VAG revealed occlusion of the fusiform aneurysm. Outflow occlusion instead of trapping is an effective surgical option for VA fusiform aneurysm to achieve obliterate the aneurysm with preservation of the perforator at the blind end.
对于因脑缺血或占位效应而出现症状的椎动脉梭形动脉瘤，应考虑手术治疗。缺血性并发症是手术或血管内栓塞术后的主要问题之一，与不良预后相关。作者报告一例椎动脉（VA）梭形动脉瘤逐渐增大并伴有缺血发作的病例，通过枕动脉-小脑后下动脉（OA-PICA）搭桥进行流出道闭塞成功治疗。一名50岁女性出现左侧小脑后下动脉供血区梗死。左侧椎动脉造影（VAG）显示左侧椎动脉V4段近端闭塞。右侧VAG显示，左侧V4段远端梭形动脉瘤样扩张部分通过椎基底动脉交界处重建，左侧小脑后下动脉是梭形动脉瘤血流的流出道。尽管对该患者进行了保守治疗，但初次就诊8个月后观察到左侧椎动脉梭形动脉瘤增大。考虑到未来发生中风或出血的潜在风险，我们对左侧小脑后下动脉起始部进行了夹闭，这样可以在保留动脉瘤周围穿支血管的情况下实现梭形动脉瘤的流出道闭塞。我们进行了枕动脉-小脑后下动脉吻合术以实现小脑后下动脉远端的血运重建。术后过程顺利，术后右侧VAG显示梭形动脉瘤闭塞。对于椎动脉梭形动脉瘤，采用流出道闭塞而非栓塞是一种有效的手术选择，可在保留盲端穿支血管的情况下实现动脉瘤闭塞。
