Shibata Aoto, Yanagawa Taro, Sugasawa Shin, Ikeda Syunsuke, Ikeda Toshiki
Stroke Center, Sagamihara Kyodo Hospital, Sagamihara, JPN.
Cureus. 2023 Mar 8;15(3):e35903. doi: 10.7759/cureus.35903. eCollection 2023 Mar.
Small cerebral aneurysms that occur at non-branching sites are generally considered to have extremely weak aneurysm walls or a pseudoaneurysm formed by a thrombus. Since conventional clipping and coil embolization are difficult and high-risk, trapping with bypass has been considered the preferred treatment method. The aim of this study is to investigate a case of trapping with high-flow bypass for a ruptured aneurysm at non-branching sites of the middle cerebral artery (MCA). In this study, the CT results indicated subarachnoid hemorrhage, while the CT angiography (CTA) results showed a small aneurysm at the non-branching site of the MCA M1 segment. Moreover, the intraoperative digital subtraction angiography (DSA) results strongly suggested a pseudoaneurysm. The aneurysm was judged to be a pseudoaneurysm over the rupture site of the true aneurysm sac. Coil embolization was performed, but the treatment was interrupted as the aneurysm completely disappeared during the procedure. However, based on the magnetic resonance angiography findings, the aneurysm reappeared on day five and became enlarged. Thus, trapping with high-flow bypass was performed on day 15 and the patient was cured. Owing to the unusual and noteworthy course of this case, trapping with high-flow bypass was considered to be the safest and most reliable first-choice treatment procedure for pseudoaneurysm at non-branching sites of the MCA.
发生在非分支部位的大脑小动脉瘤通常被认为具有极其薄弱的动脉瘤壁或由血栓形成的假性动脉瘤。由于传统的夹闭和弹簧圈栓塞困难且风险高，带血管搭桥的动脉瘤夹闭术一直被认为是首选的治疗方法。本研究的目的是探讨一例大脑中动脉（MCA）非分支部位破裂动脉瘤采用高流量搭桥夹闭术的病例。在本研究中，CT结果显示蛛网膜下腔出血，而CT血管造影（CTA）结果显示MCA M1段非分支部位有一个小动脉瘤。此外，术中数字减影血管造影（DSA）结果强烈提示为假性动脉瘤。该动脉瘤被判定为在真正动脉瘤囊破裂部位上方的假性动脉瘤。进行了弹簧圈栓塞，但由于在操作过程中动脉瘤完全消失，治疗中断。然而，根据磁共振血管造影结果，动脉瘤在第5天再次出现并增大。因此，在第15天进行了高流量搭桥夹闭术，患者治愈。由于该病例的病程不寻常且值得注意，高流量搭桥夹闭术被认为是MCA非分支部位假性动脉瘤最安全、最可靠的首选治疗方法。
