Hosainey Sayied Abdol Mohieb, Meling Torstein R
Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, 0372, Oslo, Norway.
Neurosurg Rev. 2016 Oct;39(4):711-6. doi: 10.1007/s10143-016-0769-9. Epub 2016 Jul 25.
Unruptured intracranial aneurysms occur in 1-3 % of the general population, and the risk of rupture is generally considered to be low. However, patients with multiple aneurysms and familial predisposition carry a particular risk of subarachnoid hemorrhage (SAH). A 54-year-old hypertensive man underwent screening with a head CT angiography (CTA) because of his comorbidities. CTA revealed multiple bilateral aneurysms around the circle of Willis. At first surgery, seven aneurysms were clipped (BA, ACOM, ICA ×2, and MCA ×3), two of which were detected intraoperatively only. During the second surgery, another three aneurysms were surgically clipped (PCOM and MCA ×2), one of which was detected intraoperatively. Follow-up angiography revealed another two aneurysms. A PCOM aneurysm was treated by coil embolization and a VA aneurysm clipped surgically during a third admission. The patient made an uneventful recovery. However, 4 months after his second surgery, his daughter underwent surgical clipping of a right-sided ICA aneurysm. This case report highlights both the importance of screening of high risk patients with family history of SAH, as well as its limitations, as our patient developed two de novo aneurysms during 6-month follow-up and CTA preoperatively missed three small aneurysms.
未破裂颅内动脉瘤在普通人群中的发生率为1% - 3%，一般认为其破裂风险较低。然而，患有多发性动脉瘤和有家族易感性的患者发生蛛网膜下腔出血（SAH）的风险尤其高。一名54岁的高血压男性因合并症接受了头部CT血管造影（CTA）筛查。CTA显示 Willis 环周围有多个双侧动脉瘤。在首次手术中，夹闭了7个动脉瘤（基底动脉、前交通动脉、颈内动脉×2、大脑中动脉×3），其中2个是术中才发现的。在第二次手术中，又夹闭了另外3个动脉瘤（后交通动脉和大脑中动脉×2），其中1个是术中发现的。随访血管造影显示还有另外2个动脉瘤。一个后交通动脉瘤通过弹簧圈栓塞治疗，一个椎动脉动脉瘤在第三次住院期间接受了手术夹闭。患者恢复顺利。然而，在他第二次手术后4个月，他的女儿接受了右侧颈内动脉瘤的手术夹闭。本病例报告强调了对有SAH家族史的高危患者进行筛查的重要性及其局限性，因为我们的患者在6个月的随访期间出现了2个新发动脉瘤，并且术前CTA漏诊了3个小动脉瘤。
