Batjer H, Mickey B, Samson D
Neurosurgery. 1987 Apr;20(4):624-8. doi: 10.1227/00006123-198704000-00021.
A case of angiographic enlargement and fatal rupture of a previously asymptomatic distal basilar aneurysm in a 12-year-old girl is reported. She had been treated by carotid sacrifice for a giant intracavernous carotid aneurysm. After superficial temporal-middle cerebral artery bypass, this patient underwent a trapping procedure and decompression of her symptomatic giant aneurysm. Despite postoperative patency of her bypass graft, the involved middle cerebral circulation was irrigated substantially by retrograde flow through her posterior communicating artery. An incidental distal basilar aneurysm involving the origin of her superior cerebellar arteries, posterior cerebral arteries, and multiple perforators was treated by a wrapping procedure. Eleven days after carotid ligation, she suffered a fatal subarachnoid hemorrhage from her basilar aneurysm. This catastrophe was undoubtedly produced by our failure to consider the additional hemodynamic stress placed upon the distal basilar artery by carotid sacrifice and may have been preventable by a more aggressive attack on this previously asymptomatic lesion.
报道了一例12岁女孩，其先前无症状的基底动脉远端动脉瘤造影显示增大并发生致命破裂。她曾因巨大海绵窦段颈内动脉瘤接受颈动脉结扎术。在颞浅动脉-大脑中动脉搭桥术后，该患者接受了动脉瘤夹闭术及有症状巨大动脉瘤减压术。尽管术后搭桥移植物通畅，但受累的大脑中循环主要通过后交通动脉的逆行血流进行灌注。一个偶然发现的累及小脑上动脉、大脑后动脉起始部及多个穿支的基底动脉远端动脉瘤采用包裹术治疗。颈动脉结扎术后11天，她因基底动脉瘤发生致命性蛛网膜下腔出血。这场灾难无疑是由于我们未能考虑到颈动脉结扎对基底动脉远端施加的额外血流动力学压力所致，对这个先前无症状的病变采取更积极的治疗或许可以避免这种情况发生。
