Department of Neurosurgery, Heinrich-Heine University Medical Center, Düsseldorf, Germany.
Institute of Diagnostic and Interventional Radiology, Heinrich-Heine University Medical Center, Düsseldorf, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2023 Nov;84(6):593-599. doi: 10.1055/s-0041-1739212. Epub 2021 Dec 21.
Currently, surgical revascularization procedures using intracranial-intracranial (IC-IC) or extracranial-intracranial (EC-IC) bypass and distal clipping or trapping are the valid and rescue treatment modality for extremely rare unilateral distal fusiform superior cerebellar artery (SCA) aneurysms. Yet, in case of bilateral fusiform SCA aneurysms, surgical therapy reaches its limit. Mini-flow diverter devices (FDDs) have only recently become available for treating fusiform aneurysms of such small vessels. We report the unique case of bilateral distal fusiform SCA aneurysms in a 43-year-old man with subarachnoid hemorrhage (Fisher grade IV and World Federation of Neurosurgical Societies [WFNS] grade II) treated with endovascular implantation of bilateral mini-FDDs with excellent outcome and no radiographic signs of infarction. Yet, occlusion of one of the FDDs was found in the follow-up, which again shows the eminent danger of occlusion in case of an implantation of FDDs in such small-caliber vessels, which leaves the discussion about the optimal therapy method open.
目前，使用颅内外（IC-IC）或颅外-颅内（EC-IC）旁路和远端夹闭或套扎的手术血运重建程序是治疗极为罕见的单侧远端梭形小脑上动脉（SCA）动脉瘤的有效和抢救治疗方式。然而，对于双侧梭形 SCA 动脉瘤，手术治疗已达到极限。迷你血流导向装置（FDD）最近才可用于治疗此类小血管的梭形动脉瘤。我们报告了一例独特的 43 岁男性病例，该患者患有蛛网膜下腔出血（Fisher 分级 IV 和世界神经外科学会联合会 [WFNS] 分级 II），双侧远端梭形 SCA 动脉瘤采用双侧迷你 FDD 血管内植入治疗，结果极佳，无影像学梗死迹象。然而，在随访中发现其中一个 FDD 闭塞，再次表明在如此小口径血管中植入 FDD 存在闭塞的巨大危险，这使得关于最佳治疗方法的讨论仍然存在。
