Tanahashi Kuniaki, Araki Yoshio, Uda Kenji, Muraoka Shinsuke, Motomura Kazuya, Lushun Chalise, Wakabayashi Toshihiko, Natsume Atsushi
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
World Neurosurg. 2019 Jun;126:24-29. doi: 10.1016/j.wneu.2019.02.127. Epub 2019 Mar 4.
Posterior cerebral artery (PCA) aneurysms are relatively rare, and neck clipping is often difficult due to their fusiform shape. We report a case of a thrombosed aneurysm of the distal PCA for which curative trapping and parent artery reconstruction by in situ bypass were performed through an occipital transtentorial approach (OTA).
A 67-year-old woman had been suffering from numbness in the right face and limbs for 4 months. Radiologic imaging demonstrated a thrombosed aneurysm on a distal portion of the left PCA. Curative trapping of the aneurysm and in-situ bypass between the distal PCA and superior cerebellar artery were performed through the OTA. Before surgery, we had evaluated access to the PCA and feasibility of the bypass in a cadaveric simulation. The PCA was well exposed in the posterior half of the ambient cistern, and the proximity of the distal PCA to the superior cerebellar artery through a tentorial incision was confirmed.
This OTA could represent a useful option for definitive treatment of distal PCA aneurysms.
大脑后动脉（PCA）动脉瘤相对少见，因其梭形形态，瘤颈夹闭术往往困难。我们报告1例大脑后动脉远端血栓形成性动脉瘤病例，通过枕下经小脑幕入路（OTA）进行了根治性动脉瘤夹闭及原位搭桥重建载瘤动脉。
一名67岁女性，右侧面部及肢体麻木4个月。影像学检查显示左侧大脑后动脉远端有一血栓形成性动脉瘤。通过枕下经小脑幕入路对动脉瘤进行了根治性夹闭，并在大脑后动脉远端与小脑上动脉之间进行了原位搭桥。术前，我们在尸体模拟中评估了到达大脑后动脉的入路及搭桥的可行性。大脑后动脉在环池后半部暴露良好，通过小脑幕切开确认了大脑后动脉远端与小脑上动脉的毗邻关系。
这种枕下经小脑幕入路可能是大脑后动脉远端动脉瘤确定性治疗的一个有用选择。
