Ishikawa Kohei, Endo Hideki, Shindo Koichiro, Nomura Ryota, Oka Koji, Nakamura Hirohiko
1Department of Neurosurgery, Nakamura Memorial South Hospital, Sapporo, Hokkaido, Japan; and.
2Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Hokkaido, Japan.
J Neurosurg Case Lessons. 2022 Aug 29;4(9):CASE22291. doi: 10.3171/CASE22291.
Fetal posterior cerebral artery occlusion is rare and often presents with severe neurological symptoms. Although acute recanalization therapy is commonly used for cerebral vessel occlusion, unruptured cerebral aneurysms can be hidden distal to the occluded vessels.
An 87-year-old man presented with consciousness disturbance and right hemiparesis. The authors diagnosed left fetal posterior cerebral artery occlusion and performed mechanical thrombectomy. A stent retriever was deployed from the middle cerebral artery M1 segment across the mural thrombus of the internal carotid artery. After the first pass, the fetal posterior cerebral artery remained occluded, with confirmation of a contrast effect around the thrombus. Because the anatomical course of the fetal posterior cerebral artery was unidentified, the procedure was stopped. At 1-week recovery, magnetic resonance imaging revealed complete recanalization and a fetal posterior cerebral artery aneurysm hidden within the occluded site. Blood flow was directed to the aneurysm, and the thrombus within the aneurysm simultaneously occluded the fetal posterior cerebral artery.
To avoid critical complications following mechanical thrombectomy for fetal posterior cerebral artery occlusion, hidden aneurysms should be suspected when a "fried egg-like" contrast effect is observed around the thrombus.
胎儿大脑后动脉闭塞罕见，常伴有严重神经症状。尽管急性再通治疗常用于脑血管闭塞，但未破裂的脑动脉瘤可能隐匿于闭塞血管的远端。
一名87岁男性出现意识障碍和右侧偏瘫。作者诊断为左侧胎儿大脑后动脉闭塞并进行了机械取栓术。从大脑中动脉M1段穿过颈内动脉壁血栓置入支架取栓器。首次操作后，胎儿大脑后动脉仍闭塞，血栓周围造影剂显影证实。由于胎儿大脑后动脉的解剖走行不明，手术停止。恢复1周后，磁共振成像显示完全再通，闭塞部位隐匿着一个胎儿大脑后动脉动脉瘤。血流导向动脉瘤，动脉瘤内血栓同时闭塞胎儿大脑后动脉。
为避免胎儿大脑后动脉闭塞机械取栓术后出现严重并发症，当血栓周围出现“煎蛋样”造影剂显影时，应怀疑存在隐匿性动脉瘤。
