Ozaki Tomohiko, Nishida Takeo, Fujita Yuya, Kishima Haruhiko, Kinoshita Manabu
Department of Neurosurgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan.
Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
World Neurosurg. 2018 May;113:208-211. doi: 10.1016/j.wneu.2018.02.117. Epub 2018 Feb 28.
Ruptured dissecting aneurysms located at the middle cerebral artery (MCA) are rare, and their standard treatment has not been defined. Furthermore, lenticulostriate artery involvement in the dissecting segment makes treatment extremely difficult, and no previous reports have described successful treatment for such conditions.
We herein report the case of a 74-year-old woman who presented with sudden severe headache from subarachnoid hemorrhage due to dissection in the proximal M1 segment of left MCA involving lenticulostriate arteries. Digital subtraction angiography on day 6 showed that the dissecting aneurysm had enlarged despite strict blood pressure control. On day 8, the patient was treated successfully with a self-expanding closed cell stent and coil embolization, preserving blood flow in the lenticulostriate arteries as well as the MCA.
Follow-up digital subtraction angiography performed 5 weeks after endovascular therapy showed healing of the dissecting lesion, and the patient was discharged neurologically intact.
位于大脑中动脉（MCA）的破裂夹层动脉瘤较为罕见，其标准治疗方法尚未明确。此外，豆纹动脉受累于夹层段会使治疗极具难度，且此前尚无关于此类情况成功治疗的报道。
我们在此报告一例74岁女性患者，因左大脑中动脉M1段近端夹层累及豆纹动脉导致蛛网膜下腔出血，出现突发剧烈头痛。第6天的数字减影血管造影显示，尽管严格控制血压，夹层动脉瘤仍有增大。第8天，患者通过自膨式闭孔支架和弹簧圈栓塞成功治疗，保留了豆纹动脉以及大脑中动脉的血流。
血管内治疗5周后进行的随访数字减影血管造影显示夹层病变愈合，患者出院时神经功能完好。
