Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany.
Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany.
World Neurosurg. 2019 Dec;132:103-105. doi: 10.1016/j.wneu.2019.08.206. Epub 2019 Sep 4.
We present a case of a concurrent rupture of a middle cerebral artery (MCA) aneurysm and thrombosis of the associated vessel.
A male patient presented with acute onset of hemiparesis and nuchal pain. A computed tomography scan revealed a right sided frontotemporal intracerebral hemorrhage and a basal subarachnoid hemorrhage. Owing to obliteration of the M1 segment of the MCA, no aneurysm was visible on digital subtraction angiography. Because of otherwise typical imaging for a subarachnoid hemorrhage, surgical exploration of the MCA was performed. During surgery, a thrombosed MCA bifurcation aneurysm was identified, clipped, and subsequently, endovascular (partly) recanalization of the MCA was performed.
In extremely rare cases of aneurysm rupture and subsequent thrombosis of the associated vessel, a 2-stage approach seems to be feasible. In the present case, initial surgical securing of the aneurysm followed by endovascular recanalization of the occluded vessel provided good results.
我们报告了一例大脑中动脉（MCA）动脉瘤并发血栓形成的病例。
一名男性患者突发偏瘫和颈项痛。计算机断层扫描显示右侧额颞叶脑内血肿和基底蛛网膜下腔出血。由于 MCA 的 M1 段闭塞，数字减影血管造影术（DSA）上未见动脉瘤。由于蛛网膜下腔出血的其他典型影像学表现，对 MCA 进行了手术探查。术中发现MCA 分叉部血栓形成的动脉瘤，夹闭后进行了血管内（部分）再通。
在非常罕见的情况下，动脉瘤破裂并随后发生相关血管血栓形成，两阶段治疗方法似乎是可行的。在本病例中，初始手术夹闭动脉瘤，随后对闭塞血管进行血管内再通，取得了良好的效果。
