Takarada Ayako, Yanaka Kiyoyuki, Onuma Kuniyuki, Nakamura Kazuhiro, Takahashi Nobuyuki, Ishikawa Eiichi
Departments of Neurosurgery and.
Radiology, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan; and.
J Neurosurg Case Lessons. 2021 Aug 30;2(9):CASE21360. doi: 10.3171/CASE21360.
Aplastic or twig-like middle cerebral artery (Ap/T-MCA) is a congenital MCA anomaly. It may present with symptoms of both hemorrhage and ischemia, similar to moyamoya disease, and hemodynamic stress may play an essential role in the development of symptoms in both clinical entities. The optimal treatment remains controversial in symptomatic patients with Ap/T-MCA. This report discussed the treatment method for a patient with Ap/T-MCA with unruptured aneurysms who presented with intraventricular hemorrhage (IVH) treated by aneurysm clipping and bypass surgery.
In a 46-year-old woman with a sudden headache, computed tomography showed left IVH. Magnetic resonance angiography showed a left MCA aneurysm and MCA trunk stenosis. Three-dimensional angiography demonstrated a plexiform arterial network and multiple aneurysms arising from the MCA and in the plexiform network, leading to the diagnosis of Ap/T-MCA harboring unruptured aneurysms. The patient was successfully treated by craniotomy with aneurysm clipping and bypass surgery to prevent further intracranial hemorrhages and/or aneurysm rupture.
Especially in cases such as Ap/T-MCA, in which hemodynamic stress has a significant effect, the optimal treatment method should be based on vascular morphology and the impact of hemodynamic stress.
发育不全或树枝状大脑中动脉（Ap/T-MCA）是一种先天性大脑中动脉异常。它可能出现出血和缺血症状，类似于烟雾病，并且血流动力学应激可能在这两种临床病症的症状发展中起重要作用。对于有症状的Ap/T-MCA患者，最佳治疗方法仍存在争议。本报告讨论了一名患有Ap/T-MCA且伴有未破裂动脉瘤的患者的治疗方法，该患者出现脑室内出血（IVH），接受了动脉瘤夹闭和搭桥手术治疗。
一名46岁突发头痛的女性，计算机断层扫描显示左侧脑室内出血。磁共振血管造影显示左侧大脑中动脉动脉瘤和大脑中动脉主干狭窄。三维血管造影显示一个丛状动脉网络以及多个起源于大脑中动脉和丛状网络的动脉瘤，从而诊断为伴有未破裂动脉瘤的Ap/T-MCA。该患者通过开颅动脉瘤夹闭和搭桥手术成功治疗，以防止进一步的颅内出血和/或动脉瘤破裂。
特别是在诸如Ap/T-MCA这种血流动力学应激有显著影响的病例中，最佳治疗方法应基于血管形态和血流动力学应激的影响。
