Seno Toshimoto, Kohno Kanehisa, Tanaka Hideo, Iwata Shinji, Fukumoto Shinya, Ichikawa Haruhisa, Fumoto Noriyuki, Inoue Akihiro, Ozaki Saya, Nakamura Yawara, Kohno Shohei, Ohue Shiro
Department of Neurosurgery, Stroke Center, Ehime Prefectural Central Hospital.
No Shinkei Geka. 2017 Aug;45(8):691-697. doi: 10.11477/mf.1436203576.
We report the case of a patient who has progressed well over 5 years following single-stage aneurysm clipping and superficial temporal artery-middle cerebral artery(STA-MCA)double anastomoses in the acute phase, for a ruptured distal anterior choroidal artery(AChA)aneurysm accompanied by a twig-like MCA. The patient was a 49-year-old female who developed a sudden severe headache and disturbance of consciousness due to subarachnoid hemorrhage and intraventricular hemorrhage(IVH). Cerebral angiography showed a right twig-like MCA associated with an abnormal vascular network and a ruptured aneurysm in the distal AChA. A day after emergency ventricular drainage for acute hydrocephalus, right frontotemporal craniotomy enabled distal AChA aneurysm clipping, together with removal of the IVH via transchoroidal fissure approach, in addition to STA-MCA double anastomoses to prevent recurrence of hemorrhage. The IVH resolved after surgery and no new infarct area was observed. Cerebral angiography revealed the disappearance of the aneurysm, good patency of the double bypass, and reduction of the abnormal vascular network. The patient gradually recovered without any neurological deficits, except for mild memory disturbance. Five years after the surgery, the patient has experienced no recurrence. The single-stage operation of aneurysm clipping and STA-MCA double anastomoses was made possible by devising an approach for a ruptured cerebral aneurysm, even in the acute stage. The successful improvement of cerebral circulation and prevention of cerebral hemorrhage from an early stage could serve as a reference for the treatment of similar hemorrhagic cases.
我们报告了一例患者，该患者在急性期因破裂的脉络膜前动脉（AChA）远端动脉瘤伴分支样大脑中动脉（MCA），接受了单阶段动脉瘤夹闭和颞浅动脉-大脑中动脉（STA-MCA）双吻合术，术后5年病情进展良好。患者为49岁女性，因蛛网膜下腔出血和脑室内出血（IVH）出现突发剧烈头痛和意识障碍。脑血管造影显示右侧分支样MCA伴有异常血管网，以及AChA远端动脉瘤破裂。在对急性脑积水进行紧急脑室引流一天后，通过右额颞开颅术对AChA远端动脉瘤进行夹闭，并通过脉络膜裂入路清除IVH，同时进行STA-MCA双吻合术以防止出血复发。术后IVH消失，未观察到新的梗死区域。脑血管造影显示动脉瘤消失，双旁路通畅良好，异常血管网减少。患者逐渐康复，除轻度记忆障碍外无任何神经功能缺损。术后5年，患者未出现复发。通过设计一种用于破裂脑动脉瘤的手术入路，即使在急性期也能实现动脉瘤夹闭和STA-MCA双吻合术的单阶段手术。早期成功改善脑循环并预防脑出血可为类似出血性病例的治疗提供参考。
