Anderson Tsang Chun On, Ryo Yeung Wan Lung, Fung Mak Ka, Man Lui Wai
Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
Neurointervention. 2018 Mar;13(1):62-65. doi: 10.5469/neuroint.2018.13.1.62. Epub 2018 Mar 2.
We report a case of unique location of an aneurysm at the atlanto-axial extradural segment of a unilateral aberrant vertebral artery. The MRI vessel wall imaging findings and possible mechanism of aneurysm formation were discussed. A 5 mm extracranial vertebral artery aneurysm located at the interlaminar space between C1 and C2 was diagnosed in a woman presenting with occipital headache. The index vertebral artery ran an aberrant course at the V3 segment, where it entered the dura between C1 and C2 instead of the usual atlanto-occipital space. MR vessel wall imaging showed homogenous wall enhancement of the aneurysm sac. We surmise the anomalous course of the vertebral artery subjected the V3 segment to repeated shearing force secondary to the atlanto-axial rotational neck movement. This led to vessel wall trauma and inflammation, and subsequent aneurysm formation. The aneurysm was successfully treated with endovascular coiling with resolution of symptoms.
我们报告了一例单侧异常椎动脉寰枢椎硬膜外段动脉瘤的独特位置。讨论了MRI血管壁成像结果及动脉瘤形成的可能机制。一名出现枕部头痛的女性被诊断出在C1和C2之间的椎间隙处有一个5毫米的颅外椎动脉动脉瘤。该责任椎动脉在V3段走行异常，它在C1和C2之间进入硬膜，而不是通常的寰枕间隙。磁共振血管壁成像显示动脉瘤囊壁均匀强化。我们推测椎动脉的异常走行使V3段受到寰枢椎颈部旋转运动继发的反复剪切力。这导致血管壁创伤和炎症，随后形成动脉瘤。该动脉瘤通过血管内栓塞成功治疗，症状得以缓解。
