Uchida Kazuki, Ushikoshi Satoshi, Yasuda Hiroshi
Department of Neurosurgery, Teine Keijinkai Hospital.
No Shinkei Geka. 2020 Nov;48(11):1073-1078. doi: 10.11477/mf.1436204322.
Kissing aneurysms are defined as two adjacent aneurysms arising from identical or different arteries with separate origins and partially adherent walls. Mirror aneurysms are defined as intracranial aneurysms located in similar positions bilaterally on the parent arteries. Both kissing and mirror aneurysms at the anterior communicating artery(AcomA)are rare. We report a case of subarachnoid hemorrhage(SAH)due to ruptured kissing mirror aneurysms of the AcomA. An 80-year-old woman was admitted to our hospital with a sudden headache and vomiting. CT revealed diffuse SAH. Digital subtraction arteriography(DSA)revealed an aneurysm at the right A1-A2 junction of the AcomA. Hence, coil embolization was performed. On day 14 following embolization, rebleeding occurred. DSA revealed complete occlusion of the aneurysm at the right A1-A2 junction. However, left carotid angiography revealed an aneurysm at the left A1-A2 junction. We did not understand the anatomical construction of the aneurysms;therefore, we selected microsurgical treatment to clip the AcomA aneurysm using an interhemispheric approach. The left A1-A2 junctional aneurysm was anterior to the right A1-A2 junctional aneurysm, which was coil embolized. We detected the left A1-A2 junctional aneurysm as a ruptured aneurysm. The two aneurysms were adhered to each other. After dissection to expose the aneurysmal neck, the left A1-A2 junctional aneurysm was clipped. Kissing mirror aneurysms are difficult to diagnose before treatment. Knowledge and suspicion of the occurrence of kissing mirror aneurysms in the AcomA are important.
“亲吻性动脉瘤”定义为起源于相同或不同动脉、具有独立起源且部分壁粘连的两个相邻动脉瘤。“镜像动脉瘤”定义为双侧位于母动脉相似位置的颅内动脉瘤。前交通动脉（AcomA）处的亲吻性和镜像动脉瘤均很罕见。我们报告一例因AcomA的亲吻性镜像动脉瘤破裂导致的蛛网膜下腔出血（SAH）病例。一名80岁女性因突发头痛和呕吐入院。CT显示弥漫性SAH。数字减影血管造影（DSA）显示AcomA右A1 - A2交界处有一个动脉瘤。因此，进行了弹簧圈栓塞术。栓塞后第14天，再次出血。DSA显示右A1 - A2交界处的动脉瘤完全闭塞。然而，左颈动脉血管造影显示左A1 - A2交界处有一个动脉瘤。我们不了解动脉瘤的解剖结构；因此，我们选择显微手术治疗，采用半球间入路夹闭AcomA动脉瘤。左A1 - A2交界处的动脉瘤位于已进行弹簧圈栓塞的右A1 - A2交界处动脉瘤的前方。我们检测到左A1 - A2交界处的动脉瘤为破裂动脉瘤。这两个动脉瘤相互粘连。在解剖暴露动脉瘤颈后，夹闭了左A1 - A2交界处的动脉瘤。亲吻性镜像动脉瘤在治疗前难以诊断。了解并怀疑AcomA处亲吻性镜像动脉瘤的发生很重要。
