Sorenson Thomas J, Klein Jon P, Rangel-Castilla Leonardo, Lanzino Giuseppe
School of Medicine, University of Minnesota, Twin Cities, Minneapolis, Minnesota.
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
Oper Neurosurg (Hagerstown). 2020 Apr 1;18(4):E125-E126. doi: 10.1093/ons/opz186.
Fusiform aneurysms involving the M2 branches of the middle cerebral artery are often dissecting, identified by a characteristic diseased adjacent segment, and location not at a branch point. Herein, we present the case of a 38-yr-old man with a symptomatic, dissecting M2 aneurysm that was previously incompletely treated with stent-assisted coiling. In our experience, symptomatic fusiform aneurysms in this location tend to recur unless the involved segment is completely trapped or reconstructed with flow diversion. We successfully treated this patient with a vessel reconstruction using a Pipeline Flex Embolization Device (Medtronic). Deployment of a flow diverter inside a previously placed stent can pose potential challenges, as the original stent may constrain complete expansion of the flow diverter and prevent perfect apposition against the parent vessel wall. In this operative video, we demonstrate this technique and provide a brief discussion of the potential pitfalls.
累及大脑中动脉M2分支的梭形动脉瘤通常为夹层动脉瘤，其特征为相邻节段病变，且位置不在分支点。在此，我们报告一例38岁男性患者，患有有症状的夹层M2动脉瘤，此前接受支架辅助弹簧圈栓塞治疗但未完全治愈。根据我们的经验，该部位有症状的梭形动脉瘤容易复发，除非受累节段被完全封堵或通过血流导向重建。我们使用Pipeline Flex栓塞装置（美敦力公司）成功地为该患者进行了血管重建。在先前放置的支架内植入血流导向装置可能会带来潜在挑战，因为原来的支架可能会限制血流导向装置的完全展开，并妨碍其与母血管壁完美贴合。在本手术视频中，我们展示了这项技术，并简要讨论了潜在的陷阱。
