Scullen Tyler, Mathkour Mansour, Lockwood Joseph, Ott Leah, Medel Ricky, Dumont Aaron S, Amenta Peter S
Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA.
Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA; Division of Neurosurgery, Department of Surgery, Jazan University, Jazan, Saudi Arabia.
World Neurosurg. 2018 Mar;111:349-357. doi: 10.1016/j.wneu.2017.12.129. Epub 2017 Dec 28.
Intracranial aneurysms are the leading cause of nontraumatic subarachnoid hemorrhage and are most commonly associated with the anterior cerebral artery (ACA) and anterior communicating artery complex. We describe the presentation and management of a 27-year-old man with concurrent bilateral A1-2 junction aneurysms and fusiform intraorbital ophthalmic artery (OA) aneurysms.
A 27-year-old man with no past medical history presented with 3 months of headaches. Imaging showed a large dysplastic left A1-2 junction aneurysm and a smaller saccular right A1-2 junction aneurysm, with potentially adherent domes. Two fusiform aneurysms of the intraorbital segment of the left OA were also identified. The patient underwent coil-assisted pipeline embolization of the left A1-A2 aneurysm, with complete obliteration and reconstitution of the normal parent vessel. The patient underwent coil embolization of the right A1-2 aneurysm 3 weeks later, which was found to have grown significantly at the time of treatment. Three-month follow-up showed spontaneous resolution of the OA aneurysms, persistent obliteration of the left aneurysm, and significant recurrence of the right aneurysm, which was treated with stent-assisted coil embolization. A second recurrence 3 months later was successfully treated with repeat coiling. At the time of this treatment, the patient was also found to have 2 de novo distal middle cerebral artery and ACA dysplastic aneurysms, which were not treated. Follow-up angiography 6 weeks later showed stable complete obliteration of the right A1-2 aneurysm and interval complete resolution of the dysplastic middle cerebral artery aneurysm. The distal ACA aneurysm was observed to have minimally increased in size; however, the parent vessel showed signs of interval partial thrombosis with contrast stasis within the aneurysm. This final aneurysm is being followed with serial imaging. The patient remains neurologically intact with complete resolution of his headaches.
We report the case of a young man with no past medical history who presented with multiple dysplastic aneurysms. Successful staged endovascular intervention resulted in obliteration of aneurysms with spontaneous obliteration of the intraorbital OA aneurysms observed at 3 months. We present this case to review the multiple challenges of managing complex ACA aneurysms and to highlight the usefulness of endovascular intervention in their treatment.
颅内动脉瘤是非创伤性蛛网膜下腔出血的主要原因，最常与大脑前动脉（ACA）和前交通动脉复合体相关。我们描述了一名27岁男性同时患有双侧A1 - 2交界处动脉瘤和梭形眶内眼动脉（OA）动脉瘤的临床表现及治疗情况。
一名既往无病史的27岁男性出现头痛3个月。影像学检查显示左侧A1 - 2交界处有一个大型发育异常的动脉瘤，右侧A1 - 2交界处有一个较小的囊状动脉瘤，瘤顶可能有粘连。还发现左侧眼动脉眶内段有两个梭形动脉瘤。患者接受了左侧A1 - A2动脉瘤的弹簧圈辅助血流导向装置栓塞术，动脉瘤完全闭塞，正常供血血管得以重建。3周后患者接受了右侧A1 - 2动脉瘤的弹簧圈栓塞术，治疗时发现该动脉瘤明显增大。3个月的随访显示眼动脉动脉瘤自发消退，左侧动脉瘤持续闭塞，右侧动脉瘤显著复发，遂行支架辅助弹簧圈栓塞术治疗。3个月后再次复发，通过重复弹簧圈栓塞术成功治疗。在此次治疗时，还发现患者有2个新发的大脑中动脉远端和ACA发育异常的动脉瘤，未予治疗。6周后的随访血管造影显示右侧A1 - 2动脉瘤稳定完全闭塞，发育异常的大脑中动脉动脉瘤同期完全消退。观察到远端ACA动脉瘤大小略有增加；然而，供血血管显示有间隔性部分血栓形成，动脉瘤内有造影剂滞留。最后这个动脉瘤通过系列影像学检查进行随访。患者头痛完全缓解，神经系统检查无异常。
我们报告了一例既往无病史的年轻男性患有多个发育异常动脉瘤的病例。成功的分期血管内介入治疗使动脉瘤闭塞，3个月时观察到眶内眼动脉动脉瘤自发闭塞。我们展示此病例以回顾处理复杂ACA动脉瘤的多重挑战，并强调血管内介入治疗在其治疗中的有用性。
