Department of Diagnostic Imaging - Vascular and Interventional Radiology Unit E.O. Galliera Hospital Mura delle Cappuccine, 14 - 16128 Genova, ITALY.
Department of Diagnostic Imaging - Diagnostic and Interventional Neuroradiology Unit E.O. Galliera Hospital Mura delle Cappuccine, 14 - 16128 Genova, ITALY.
Acta Neurol Taiwan. 2023 Dec 30;32(4):226-227.
A 70-year-old woman with a history of hypertension developed acute onset of severe tightness headache accompanied by vomiting. Patient reported having right diplopia and occasional and temporary right peripheral facial paralysis for two weeks. Neurological examination revealed only a right squint. Cerebral multi-detector computed tomographic angiography (MD-CTA) and Magnetic Resonance Imaging (MRI) revealed a giant right internal carotid aneurysm (2.7 cm) at the cavenous segment (Figure 1A, 1B). No abnormalities were noted in subarachnoid spaces and white - grey matter. A selective digital subtraction angiography (DSA) of the right internal carotid artery confirmed the giant aneurysm at the cavenous segment (Figure 2A, 2B). Subsequently endovascular flow-diverting stent was deployed at the cavernous segment of the right internal carotid artery to treat over time the giant aneurysm. Her clinical course has no neurological symptoms and she was discharged after two days with established over time clinical and imaging follow-up. Giant intracranial aneurysms and vascular anomalies of the internal carotid are rare, and are defined "giant" those greater than 2.5 cm in diameter (1-4). Conservative treatment of giant intracranial aneurysms have a mortality rates of 65-100% in 2-5 years (4). Clinical presentation of internal carotid aneurysms at the petrous segment can manifest from no-symptom to headache, cranial nerve disturbs and epistaxis (1- 4). MD-CTA and MRI are the two gold standard methods for diagnosis in patients with suspected internal carotid artery and intracranial artery aneurysm (1,5). Internal carotid aneurysms at the cavenous segment are located in a surgically difficult accessible area, therefore endovascular percutaneous techniques are considered the first lines treatments (6).
一位 70 岁的老年女性，有高血压病史，突发严重紧张性头痛，伴有呕吐。患者报告说有右侧复视，并伴有两周偶尔和短暂的右侧周围性面瘫。神经系统检查仅显示右侧斜视。脑多探测器 CT 血管造影（MD-CTA）和磁共振成像（MRI）显示右侧颈内动脉海绵窦段有一个巨大的动脉瘤（2.7 厘米）（图 1A、1B）。蛛网膜下腔和灰白质无异常。右侧颈内动脉选择性数字减影血管造影（DSA）证实海绵窦段有巨大动脉瘤（图 2A、2B）。随后，在右侧颈内动脉海绵窦段放置了血管内血流导向支架，以随时间推移治疗巨大动脉瘤。她的临床过程没有神经系统症状，两天后出院，并进行了随时间推移的临床和影像学随访。颅内巨大动脉瘤和颈内动脉血管畸形较为罕见，定义为直径大于 2.5 厘米的“巨大”动脉瘤（1-4）。2-5 年内，保守治疗颅内巨大动脉瘤的死亡率为 65-100%（4）。岩骨段颈内动脉瘤的临床表现从无症状到头痛、颅神经障碍和鼻出血不等（1-4）。MD-CTA 和 MRI 是疑似颈内动脉和颅内动脉动脉瘤患者的两种金标准诊断方法（1,5）。海绵窦段颈内动脉瘤位于手术难以触及的区域，因此血管内经皮技术被认为是一线治疗方法（6）。
