Noh Yunho, Lee Sung Ho, Yoon Seok Mann, Song In Hag, Oh Jae Sang
Department of Neurosurgery, Cheonan Hospital, Soonchunhyang University School of Medicine, Cheonan, Korea.
Department of Cardiothoracic surgery, Cheonan Hospital, Soonchunhyang University School of Medicine, Cheonan, Korea.
J Cerebrovasc Endovasc Neurosurg. 2021 Dec;23(4):359-364. doi: 10.7461/jcen.2021.E2021.06.004. Epub 2021 Dec 29.
Partially thrombosed intracranial aneurysm was difficult to treat because of higher recurrence rate compared to non-thrombosed saccular aneurysm. The author reports a case of partially thrombosed intracranial aneurysm causing transient ischemic symptom. A 40-year-old man presented with transient right hemiparesis. Brain magnetic resonance imaging (MRI) depicted low-signal intensity target-like mass lesion on left sylvian fissure, and magnetic resonance angiography (MRA) showed aneurysm on left middle cerebral artery bifurcation (MCBF), suggested thrombosed aneurysm. On operative finding, aneurysm wall had thick and atherosclerotic change, and it was fusiform aneurysm not saccular type. We initially planned direct clip for the aneurysm, but it was failed due to collapse of parent artery after clipping on aneurysm neck. To prevent ischemia, extracranial-intracranial bypass was performed and then thrombectomy with clip reconstruction. To remodeling the fusiform aneurysm, stent-assisted coiling was performed for remnant portion of aneurysm. With staged hybrid technique, giant thrombosed fusiform aneurysm was completely obliterated and the patient did not suffer any neurologic symptoms no longer.
与未血栓形成的囊状动脉瘤相比，部分血栓形成的颅内动脉瘤由于复发率较高而难以治疗。作者报告了一例导致短暂性缺血症状的部分血栓形成的颅内动脉瘤病例。一名40岁男性出现短暂性右侧偏瘫。脑部磁共振成像（MRI）显示左侧外侧裂有低信号强度的靶样肿块病变，磁共振血管造影（MRA）显示左侧大脑中动脉分叉处（MCBF）有动脉瘤，提示为血栓形成的动脉瘤。手术中发现，动脉瘤壁有增厚和动脉粥样硬化改变，为梭形动脉瘤而非囊状类型。我们最初计划对动脉瘤进行直接夹闭，但由于在动脉瘤颈部夹闭后供血动脉塌陷而失败。为防止缺血，进行了颅外-颅内搭桥术，然后进行血栓切除术并重建夹子。为重塑梭形动脉瘤，对动脉瘤的残余部分进行了支架辅助弹簧圈栓塞术。采用分期杂交技术，巨大血栓形成的梭形动脉瘤被完全闭塞，患者不再出现任何神经症状。
