Shimizu Yu, Miyashita Katsuyoshi, Oikawa Nozomu, Kobayashi Masaaki, Tohma Yasuo
Department of Neurosurgery, Fukui Prefectural Hospital, Fukui, Japan.
Surg Neurol Int. 2021 Feb 17;12:64. doi: 10.25259/SNI_582_2020. eCollection 2021.
A spherical intracranial mass can be occasionally misdiagnosed due to the lack of typical radiographic features. Completely thrombosed intracranial aneurysms (CTIA) are uncommon, but a possible differential diagnosis must be considered to guarantee the best surgical approach for these lesions.
Here, we report an extremely rare case of a right frontal mass mimicking a brain tumor, in which the surgery unveiled a CTIA of the right middle cerebral artery (MCA). A 56-year-old woman presented with right hemiparesis and mild headache. Magnetic resonance imaging (MRI) revealed a right frontal mass with peripheral edema. The lesion enhanced on initial and follow-up MRI of the brain. Subsequent vascular studies and metastatic workup were negative. A temporal craniotomy with neuronavigation (Brain Lab AG, Germany) was performed and an intraoperative diagnosis of a thrombosed aneurysm along the branch of the MCA was established. The aneurysm was successfully trapped and resected. The patient did not exhibit any postoperative neurological deficits.
This is the rare report of a ring enhanced completely thrombosed aneurysm due to vasa vasorum which is misdiagnosed as metastatic brain tumor. In case of an intracranial ring enhanced mass with signs of intralesional hemorrhage and peripheral edema, CTIA should be considered as a possible differential diagnosis.
由于缺乏典型的影像学特征，球形颅内肿块偶尔会被误诊。完全血栓形成的颅内动脉瘤（CTIA）并不常见，但必须考虑其作为可能的鉴别诊断，以确保针对这些病变采取最佳手术方法。
在此，我们报告一例极为罕见的病例，一名右额叶肿块酷似脑肿瘤的患者，手术中发现是大脑中动脉（MCA）右侧的一个完全血栓形成的颅内动脉瘤。一名56岁女性出现右侧偏瘫和轻度头痛。磁共振成像（MRI）显示右额叶有一肿块伴周边水肿。该病变在脑部初次及随访MRI检查中均有强化。随后的血管检查和转移灶检查均为阴性。采用德国Brain Lab AG公司的神经导航系统进行了颞部开颅手术，术中诊断为沿大脑中动脉分支的血栓形成动脉瘤。该动脉瘤成功被夹闭并切除。患者术后未出现任何神经功能缺损。
这是一例罕见的因滋养血管导致环状强化的完全血栓形成动脉瘤被误诊为脑转移瘤的病例报告。对于出现瘤内出血和周边水肿迹象的颅内环状强化肿块，应考虑完全血栓形成的颅内动脉瘤作为可能的鉴别诊断。
