Suzuki Tomoaki, Hasegawa Hitoshi, Ando Kazuhiro, Shibuya Kohei, Takahashi Haruhiko, Saito Shoji, On Jotaro, Oishi Makoto, Fujii Yukihiko
Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan.
Surg Neurol Int. 2021 Feb 10;12:49. doi: 10.25259/SNI_780_2020. eCollection 2021.
Perianeurysmal edema (PAE) has been suggested as an indicator of potential aneurysm rupture; however, the hemodynamic features of these aneurysms are still unknown. A computational fluid dynamic (CFD) analysis was performed to evaluate the hemodynamic features of a very rare case of a ruptured middle cerebral artery (MCA) aneurysm with PAE.
A 65-year-old woman presented with disturbed consciousness. A subarachnoid hemorrhage due to an azygos anterior cerebral artery (ACA) aneurysm rupture was suspected. An unruptured MCA aneurysm with PAE was identified in the left temporal lobe. Although the ACA aneurysm was clipped to prevent re-bleeding, the MCA aneurysm subsequently ruptured 6 days later. Clipping of the MCA aneurysm was performed, and hemosiderin deposits suggestive of sentinel bleeding were found on the surface of the aneurysm dome. CFD analysis revealed unstable hemodynamic stress at the expanded bleb area after rupture, localized to the rupture site. Moreover, this analysis revealed flow impingement with pressure elevation and low wall shear stress, which indicated increased inflammation and aneurysm wall thinning that likely led to rupture.
Hemosiderin deposits at the aneurysm wall and PAE indicates leakage from a cerebral aneurysm. Hemodynamic stress at the aneurysm may promote an inflammatory response and lead to wall weakening accompanied by PAE. Based on our findings, we recommend that surgical intervention should be considered as the first line of treatment for such aneurysms to prevent rupture.
瘤周水肿（PAE）被认为是潜在动脉瘤破裂的一个指标；然而，这些动脉瘤的血流动力学特征仍不清楚。进行了计算流体动力学（CFD）分析，以评估一例非常罕见的伴有PAE的破裂大脑中动脉（MCA）动脉瘤的血流动力学特征。
一名65岁女性出现意识障碍。怀疑是由于奇静脉大脑前动脉（ACA）动脉瘤破裂导致的蛛网膜下腔出血。在左颞叶发现一个伴有PAE的未破裂MCA动脉瘤。尽管对ACA动脉瘤进行了夹闭以防止再次出血，但MCA动脉瘤随后在6天后破裂。对MCA动脉瘤进行了夹闭，并且在动脉瘤穹窿表面发现了提示哨兵出血的含铁血黄素沉积。CFD分析显示破裂后膨出泡区域存在不稳定的血流动力学应力，局限于破裂部位。此外，该分析显示存在血流冲击，伴有压力升高和低壁面切应力，这表明炎症增加和动脉瘤壁变薄，可能导致破裂。
动脉瘤壁的含铁血黄素沉积和PAE表明存在脑动脉瘤渗漏。动脉瘤处的血流动力学应力可能促进炎症反应，并导致伴有PAE的动脉瘤壁变薄。基于我们的研究结果，我们建议对于此类动脉瘤应考虑将手术干预作为预防破裂的一线治疗方法。
