Inamasu Joji, Nakae Shunsuke, Kato Yoko, Hirose Yuichi
Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan.
Asian J Neurosurg. 2018 Jul-Sep;13(3):779-781. doi: 10.4103/ajns.AJNS_213_16.
We present a case of a partially thrombosed giant aneurysm of the pericallosal artery that experienced a temporary worsening of perianeurysmal edema after clipping. A 66-year-old man presented with progressive weakness of the right leg. Imaging studies revealed a partially thrombosed giant aneurysm at the bifurcation of the left pericallosal artery with concomitant perianeurysmal edema. The aneurysm was thought responsible for the symptoms of the patient, and he agreed to undergo clipping surgery. The aneurysmal neck was clipped using two long aneurysm clips without dissecting the aneurysmal dome. The patient woke up from anesthesia with the right-sided hemiparesis, which progressed to hemiplegia by 12 h after surgery. Brain computed tomography revealed worsening of the perianeurysmal edema. Fortunately, his symptoms resolved completely by 2 weeks after surgery with conservative management. Perianeurysmal edema is frequently observed in patients with partially thrombosed giant aneurysms. Although worsening of perianeurysmal edema is a relatively common complication of endovascular procedures, its occurrence after clipping has rarely been reported. The worsening may have been induced by release of inflammatory cytokines from aneurysm wall, which was rendered ischemic due to obliteration of the vasa vasorum by the clips. Perianeurysmal edema may develop or worsen after clipping of a partially thrombosed giant aneurysm if the interface between the aneurysm and surrounding brain is not fully dissected.
我们报告一例胼周动脉部分血栓形成的巨大动脉瘤，夹闭术后瘤周水肿出现暂时加重。一名66岁男性因右腿进行性无力就诊。影像学检查显示左胼周动脉分叉处有一个部分血栓形成的巨大动脉瘤，伴有瘤周水肿。该动脉瘤被认为是导致患者症状的原因，患者同意接受夹闭手术。使用两个长动脉瘤夹夹闭动脉瘤颈部，未分离动脉瘤穹窿。患者术后麻醉苏醒时出现右侧偏瘫，术后12小时进展为偏瘫。脑部计算机断层扫描显示瘤周水肿加重。幸运的是，经保守治疗，患者术后2周症状完全缓解。部分血栓形成的巨大动脉瘤患者常可见瘤周水肿。虽然瘤周水肿加重是血管内介入治疗相对常见的并发症，但其在夹闭术后的发生鲜有报道。这种加重可能是由于动脉瘤壁释放炎性细胞因子所致，而动脉瘤壁因夹子闭塞滋养血管而缺血。如果未充分分离动脉瘤与周围脑组织之间的界面，部分血栓形成的巨大动脉瘤夹闭术后瘤周水肿可能会发展或加重。
