Otawa Masato, Izumi Takashi, Nishihori Masahiro, Tsukada Tetsuya, Oshima Ryosuke, Kawaguchi Tomomi, Goto Shunsaku, Ikezawa Mizuka, Kropp Asuka Elisabeth, Wakabayashi Toshihiko
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
NMC Case Rep J. 2021 Apr 2;8(1):57-61. doi: 10.2176/nmccrj.cr.2020-0036. eCollection 2021 Apr.
We describe a case of pulsatile anterior communicating artery aneurysm (A-com AN) with a peculiar angiographic appearance. An 81-year-old man was referred to the department of neurosurgery for a large A-com AN artery aneurysm, which was detected incidentally. The patient hoped not to be treated but to be followed up. After 4 months, magnetic resonance imaging (MRI) revealed the presence of a cerebral edema and hematoma around the aneurysm, and partial thrombus in the upper wall of the aneurysm was suspected. Based on these findings, the patient underwent an immediate coil embolization a day after admission. However, the portion of the neck remnant increased in size after the first procedure. Therefore, 8 months after the initial procedure, he was treated with stent coil embolization. Contrary to the first procedure, angiographic evaluation revealed an active pulsating aneurysm. Moreover, MRI revealed the presence of a partial thrombus in the upper neck segment of the aneurysm, with an intensity that changed over time. The patient underwent cautious treatment and was discharged without any symptoms. This is the first case study to reveal an A-com AN with active pulsation and the relationship between the pulsatile portion of the aneurysm and thrombosed portion by MRI.
我们描述了一例具有特殊血管造影表现的搏动性前交通动脉瘤（A-com AN）。一名81岁男性因偶然发现的大型A-com AN动脉瘤被转诊至神经外科。患者希望不接受治疗而是进行随访。4个月后，磁共振成像（MRI）显示动脉瘤周围存在脑水肿和血肿，怀疑动脉瘤上壁有部分血栓形成。基于这些发现，患者入院一天后立即接受了弹簧圈栓塞治疗。然而，首次手术后颈部残余部分的尺寸增大。因此，在首次手术后8个月，他接受了支架辅助弹簧圈栓塞治疗。与首次手术相反，血管造影评估显示为活动性搏动性动脉瘤。此外，MRI显示动脉瘤上颈部段存在部分血栓，其信号强度随时间变化。患者接受了谨慎治疗，出院时无任何症状。这是首例揭示具有活动性搏动的A-com AN以及通过MRI显示动脉瘤搏动部分与血栓形成部分之间关系的病例研究。
