Division of Neurosurgery, Krembil Research Institute, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, ON, Canada.
Department of Neurosurgery & Skull Base Surgery, Hospital Ernesto Dornelles, Porto Alegre, Brazil.
Acta Neurochir Suppl. 2023;130:81-84. doi: 10.1007/978-3-030-12887-6_10.
An unexpected rupture at the aneurysm neck, with or without adjacent arterial injury or compromise of distal branches during microsurgical clipping, can be a challenging surgical problem to resolve. In this presented case of a neurologically intact 65-year-old woman, elective clipping of an unruptured right middle cerebral artery bifurcation aneurysm was complicated by an unexpected M2 tear at the neck, involving the origin of the frontal M2. Attempts to seal the tear directly, using various techniques, failed; therefore, it was ultimately managed with sacrifice of the vessel and a salvage side-to-side M2-to-M2 in situ bypass. Six months after surgery, the patient demonstrated moderate disability but was able to ambulate with a cane.
在显微手术夹闭过程中，动脉瘤颈部的意外破裂，无论是伴有还是不伴有邻近动脉损伤或远端分支受压，都是一个具有挑战性的手术问题。在这个病例中，一位 65 岁的神经功能正常的女性，在选择性夹闭未破裂的右侧大脑中动脉分叉部动脉瘤时，颈部的 M2 撕裂出乎意料，涉及额 M2 的起源。使用各种技术直接封闭撕裂口的尝试均失败，因此最终采用牺牲血管并进行挽救性的原位 M2-M2 侧侧搭桥术来处理。术后 6 个月，患者表现出中度残疾，但能够用拐杖行走。
