采用A3 - A3吻合术进行流出道闭塞治疗环形部分血栓形成的巨大A2动脉瘤。
Outflow occlusion with A3-A3 anastomosis for a doughnut-shaped partially thrombosed giant A2 aneurysm.
作者信息
Ito Hidemichi, Miyano Ryotaro, Sase Taigen, Wakui Daisuke, Matsumori Takashi, Takasuna Hiroshi, Oshio Kotaro, Tanaka Yuichiro
机构信息
Department of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan.
出版信息
Surg Neurol Int. 2016 Dec 21;7(Suppl 41):S1069-S1071. doi: 10.4103/2152-7806.196379. eCollection 2016.
BACKGROUND
A doughnut-shaped aneurysm, which is defined as a round-shaped aneurysm composed of an intraluminar thrombus and marginal parent artery, is an extremely uncommon subtype of partially thrombosed giant aneurysms. Surgical treatment of this characteristic aneurysm is technically challenging.
CASE DESCRIPTION
We report a rare case of a 79-year-old man with a symptomatic doughnut-shaped giant aneurysm at the A2 portion, which was successfully treated by outflow occlusion with an A3-A3 side-to-side anastomosis. Postoperative angiograms demonstrated no filling of the doughnut-shaped aneurysm and perfusion in the distal right anterior cerebral artery territory via the anastomosis. Follow-up magnetic resonance imaging 1 year after the surgery demonstrated significant diminution of the aneurysm.
CONCLUSIONS
Outflow occlusion with distal revascularization could be an effective surgical option for such a unique aneurysm. To the best of our knowledge, this is the first report of outflow occlusion as a therapy for doughnut-shaped aneurysms.
背景
甜甜圈形动脉瘤被定义为由腔内血栓和边缘供血动脉组成的圆形动脉瘤，是部分血栓形成的巨大动脉瘤中极为罕见的亚型。对这种具有特征性的动脉瘤进行手术治疗在技术上具有挑战性。
病例描述
我们报告了一例罕见病例，一名79岁男性，其A2段出现有症状的甜甜圈形巨大动脉瘤，通过A3 - A3侧侧吻合进行流出道闭塞成功治疗。术后血管造影显示甜甜圈形动脉瘤未显影，且通过吻合口右侧大脑前动脉远端区域有灌注。术后1年的随访磁共振成像显示动脉瘤明显缩小。
结论
远端血管重建的流出道闭塞可能是治疗这种独特动脉瘤的有效手术选择。据我们所知，这是关于流出道闭塞治疗甜甜圈形动脉瘤的首例报告。
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