Sai Kiran Narayanam Anantha, Kiran Kumar Veldurti Ananta, Kumar Valluri Anil, Agrawal Amit
Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India.
Department of Neuroanaesthesia, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India.
Asian J Neurosurg. 2019 Nov 25;14(4):1214-1217. doi: 10.4103/ajns.AJNS_157_19. eCollection 2019 Oct-Dec.
A 46-year-old male presented with a history of sudden severe headache 1 week back, altered sensorium and right hemiparesis for 2 days. On examination, Glasgow Coma Scale (GCS) was E4V4M6 and the patient had right hemiparesis (power - 4/5). Computed tomography (CT) revealed diffuse subarachnoid hemorrhage (Fisher's Grade III). CT angiogram revealed distal basilar trunk aneurysm arising between the origin of the left posterior cerebral artery and superior cerebellar artery, ectatic dilatation of distal basilar trunk, and a left middle cerebral artery (MCA) bifurcation aneurysm. Basilar trunk aneurysm was approached through subtemporal route and aneurysm was clipped during adenosine-induced profound hypotension (AIPH) without application of temporary clip. Single bolus 6 mg of adenosine was given, and aneurysm was successfully clipped during AIPH (systolic <60 mmHg). There were no complications related to adenosine. Ectatic part of distal basilar trunk was wrapped with Teflon. The left MCA bifurcation aneurysm was clipped in the same session. At 3-month follow-up, the patient's sensorium was normal (GCS-E4V5M6) and the right hemiparesis improved (4+/5). Adenosine enhances the safety of clipping these aneurysms by providing transient cardiac arrest or profound hypotension. In developing countries, microsurgical clipping is a cost-effective treatment option for basilar artery aneurysms.
一名46岁男性，1周前突发剧烈头痛，意识改变及右侧偏瘫2天。检查时，格拉斯哥昏迷量表（GCS）评分为E4V4M6，患者有右侧偏瘫（肌力4/5）。计算机断层扫描（CT）显示弥漫性蛛网膜下腔出血（Fisher分级III级）。CT血管造影显示基底动脉干远端动脉瘤位于左大脑后动脉起始部与小脑上动脉之间，基底动脉干远端扩张，以及左侧大脑中动脉（MCA）分叉处动脉瘤。通过颞下途径处理基底动脉干动脉瘤，在腺苷诱导的深度低血压（AIPH）期间夹闭动脉瘤，未应用临时夹。给予单次推注6mg腺苷，在AIPH期间（收缩压<60mmHg）成功夹闭动脉瘤。未出现与腺苷相关的并发症。基底动脉干远端扩张部分用特氟龙包裹。在同一次手术中夹闭左侧MCA分叉处动脉瘤。在3个月的随访中，患者意识正常（GCS-E4V5M6），右侧偏瘫改善（4+/5）。腺苷通过提供短暂心脏骤停或深度低血压提高了夹闭这些动脉瘤的安全性。在发展中国家，显微手术夹闭是治疗基底动脉动脉瘤的一种经济有效的选择。
