Rashad Sherif, Endo Hidenori, Sultan Ahmed Elsayed, Shimizu Hiroaki, Fujimura Miki, Sato Kenichi, Matsumoto Yasushi, Tominaga Teiji
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):e227-30. doi: 10.1016/j.jstrokecerebrovasdis.2015.04.024. Epub 2015 May 14.
We describe a rare case with partially thrombosed fusiform anterior choroidal artery (AchA) aneurysm successfully treated with therapeutic occlusion of the AchA.
A 58-year-old man presented with transient mild hemiparesis of the right side. Magnetic resonance imaging (MRI) showed an ischemic lesion in the posterior limb of the left internal capsule. Digital subtraction angiography (DSA) revealed a left internal carotid artery saccular aneurysm (14.5-mm diameter) arising from the supraclinoid segment. The left AchA was not detected in the initial DSA, and MRI showed the aneurysm to be partially thrombosed. The second DSA performed 2 weeks after the onset showed recanalization of the thrombosed portion of the aneurysm with the left AchA apparently arising from its tip. The aneurysm was diagnosed as a partially thrombosed fusiform AchA aneurysm.
Open surgery was performed and a titanium clip was applied to the base of the fusiform aneurysm under motor evoked potential monitoring, which remained unchanged after clipping. Occlusion of the aneurysm was confirmed by Doppler ultrasound and intraoperative fluorescence angiography. Furthermore, Doppler ultrasound and fluorescence angiography showed that the blood flow supplying the pyramidal tract was reconstituted by the retrograde collateral flow from the choroidal segment. The aneurysm was completely obliterated in postoperative DSA, which demonstrated retrograde filling of the AchA through the posterior circulation. The patient manifested transient weakness of the right side postoperatively, which was completely recovered after short-term rehabilitation.
This case illustrates the unique clinical course of a rare partially thrombosed fusiform AchA aneurysm, successfully treated with therapeutic clip occlusion of the AchA under the multimodal monitoring.
我们描述了一例罕见的部分血栓形成的梭形脉络膜前动脉（AchA）动脉瘤，通过对AchA进行治疗性闭塞成功治愈。
一名58岁男性出现右侧短暂性轻度偏瘫。磁共振成像（MRI）显示左侧内囊后肢有缺血性病变。数字减影血管造影（DSA）显示颈内动脉海绵窦段上方有一个囊状动脉瘤（直径14.5毫米）。初次DSA未检测到左侧AchA，MRI显示动脉瘤部分血栓形成。发病2周后进行的第二次DSA显示动脉瘤血栓形成部分再通，左侧AchA明显起源于其尖端。该动脉瘤被诊断为部分血栓形成的梭形AchA动脉瘤。
进行了开放手术，在运动诱发电位监测下将钛夹应用于梭形动脉瘤的基部，夹闭后电位未发生变化。通过多普勒超声和术中荧光血管造影确认动脉瘤闭塞。此外，多普勒超声和荧光血管造影显示，供应锥体束的血流通过脉络膜段的逆行侧支循环得以重建。术后DSA显示动脉瘤完全闭塞，显示AchA通过后循环逆行充盈。患者术后出现右侧短暂性无力，经短期康复后完全恢复。
本病例说明了罕见的部分血栓形成的梭形AchA动脉瘤独特的临床病程，通过在多模式监测下对AchA进行治疗性夹闭成功治愈。
