Watanabe Yosuke, Takechi Akihiko, Kajiwara Yoshinori, Miyoshi Hiroyuki
Department of Neurosurgery, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan.
J Neuroendovasc Ther. 2021;15(2):107-112. doi: 10.5797/jnet.cr.2020-0040. Epub 2020 Sep 16.
We report a rare case of a ruptured anterior spinal artery (ASA) aneurysm caused by bilateral vertebral artery (VA) occlusion.
A 78-year-old man suddenly developed severe headache and slight hemiparesis, and was admitted to our hospital. Computed tomography (CT) revealed subarachnoid hemorrhage, mainly in the posterior fossa. On emergency angiography, the right VA terminated at the origin of the posterior inferior cerebellar artery (PICA), and anastomoses between the PICA and the anterior inferior cerebellar artery (AICA) were observed, in addition to a saccular 3-mm aneurysm with bleb originating from the PICA-AICA anastomosis. Left vertebral arteriography demonstrated that the left VA was occluded segmentally at the V4 level and revealed a tortuous arterial network filling the distal VA. Based on the location of the bleeding, the right VA aneurysm was considered to have ruptured. After balloon test occlusion of the right VA, parent artery occlusion was performed without complications. The patient had no neurological changes immediately after surgery, but several hours later, he stopped breathing. Retrospective analysis revealed an ASA aneurysm, which was determined to be the bleeding source. Although conservative treatment was performed, he died the fourth day after onset without neurological improvement.
In cases of subarachnoid hemorrhage associated with bilateral VA occlusion, an aneurysm formed by hemodynamic stress may be the source of hemorrhage. It is important to suspect aneurysms in the extracranial collaterals, such as the ASA, and intracranial collaterals such as the PICA-AICA anastomosis.
我们报告一例罕见的因双侧椎动脉闭塞导致的脊髓前动脉（ASA）动脉瘤破裂病例。
一名78岁男性突然出现严重头痛和轻度偏瘫，被收治入院。计算机断层扫描（CT）显示蛛网膜下腔出血，主要位于后颅窝。急诊血管造影显示，右侧椎动脉在小脑后下动脉（PICA）起始处终止，观察到PICA与小脑前下动脉（AICA）之间存在吻合，此外还发现一个起源于PICA - AICA吻合处的3毫米囊状带小泡动脉瘤。左侧椎动脉造影显示左侧椎动脉在V4水平节段性闭塞，并显示一个蜿蜒的动脉网络填充远端椎动脉。基于出血部位，考虑右侧椎动脉动脉瘤破裂。在对右侧椎动脉进行球囊试验闭塞后，进行了供血动脉闭塞，未出现并发症。术后患者立即无神经功能改变，但数小时后呼吸停止。回顾性分析发现一个ASA动脉瘤，确定为出血源。尽管进行了保守治疗，但患者在发病后第四天死亡，神经功能无改善。
在双侧椎动脉闭塞相关的蛛网膜下腔出血病例中，由血流动力学压力形成的动脉瘤可能是出血源。怀疑颅外侧支循环（如ASA）和颅内侧支循环（如PICA - AICA吻合处）存在动脉瘤很重要。
