Inoue Hirotaka, Kawano Takayuki, Kaku Yasuyuki, Mukasa Akitake
Department of Neurosurgery, Kumamoto General Hospital, Yatsushiro, Kumamoto, Japan.
Department of Neurosurgery, School of Medicine, Kurume University, Kurume, Fukuoka, Japan.
Surg Neurol Int. 2021 Apr 26;12:195. doi: 10.25259/SNI_249_2021. eCollection 2021.
Partially thrombosed anterior inferior cerebellar artery (AICA) aneurysms are extremely rare; thus, no established therapeutic approach exists.
We report a large, partially thrombosed AICA aneurysm and discuss its therapeutic nuances. The aneurysm was asymptomatic; therefore, we aimed to treat it through a minimally invasive procedure. The aneurysm was of fusiform type and the proximal neck of the aneurysm was positioned at midline in front of the brainstem. To approach the neck, posterior transpetrosal approach is recommended. However, this approach can be invasive; thus, we performed distal clipping of the aneurysm using transcondylar fossa approach with occipital artery-AICA bypass to avoid ischemia of the AICA territory. Although the size of the aneurysm initially increased, it subsequently decreased.
This is a rare case report describing the long-term clinical course after distal clipping in detail. We showed that traditional microsurgical techniques can be applied to treat patients with new, minimally invasive treatment strategies.
小脑前下动脉(AICA)部分血栓形成的动脉瘤极为罕见;因此,尚无既定的治疗方法。
我们报告一例大型、部分血栓形成的AICA动脉瘤,并讨论其治疗细节。该动脉瘤无症状;因此,我们旨在通过微创手术对其进行治疗。该动脉瘤为梭形,动脉瘤近端颈部位于脑干前方中线处。为接近颈部,推荐采用经岩骨后入路。然而,该入路可能具有侵袭性;因此,我们采用经髁窝入路并进行枕动脉-AICA搭桥术对动脉瘤进行远端夹闭,以避免AICA供血区域缺血。尽管动脉瘤大小最初有所增加,但随后减小。
这是一篇罕见的病例报告,详细描述了远端夹闭后的长期临床过程。我们表明,传统显微外科技术可应用于采用新的微创治疗策略的患者。