Romano Andrea, Moltoni Giulia, Piazza Amedeo, Trasimeni Guido, Miscusi Massimo, Palizzi Serena, Romano Allegra, Raco Antonino, Bozzao Alessandro
NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy.
Radiol Case Rep. 2023 Oct 4;18(12):4384-4388. doi: 10.1016/j.radcr.2023.09.014. eCollection 2023 Dec.
Giant serpentine aneurysms are rare huge and partially thrombosed aneurysms, with an eccentric tortuous intra-aneurysmal vascular channel. Surgical treatment is often necessary due to the great mass effect. We describe a case of a left-handed woman with a giant serpentine aneurysm of the left middle cerebral artery whose management was complex. The challenge was to exclude the aneurysm from circulation, reduce the mass effect, and, mostly, preserve the language function. Since the patient was left-handed the language dominance needed to be assessed; functional MRI (fMRI) and Wada test (WT) showed a right dominance. Surgical treatment was performed, as a complication, the patient developed left fronto-basal ischemia with a slight paresis of the right hand but without any language deficit. Our case shows the importance of a multidisciplinary team in patient management, with a pivotal role of neuroradiological functional tests in presurgical planning.
巨大蜿蜒状动脉瘤是罕见的巨大且部分血栓形成的动脉瘤，具有偏心迂曲的瘤内血管通道。由于巨大的占位效应，通常需要进行手术治疗。我们描述了一例左手中风的女性患者，患有左大脑中动脉巨大蜿蜒状动脉瘤，其治疗过程复杂。面临的挑战是将动脉瘤排除在循环之外，减轻占位效应，并且最重要的是保留语言功能。由于患者是左利手，需要评估语言优势半球；功能磁共振成像（fMRI）和Wada试验（WT）显示为右侧优势半球。进行了手术治疗，作为并发症，患者出现左额底部缺血，右手轻度无力，但无任何语言缺陷。我们的病例显示了多学科团队在患者管理中的重要性，神经放射学功能测试在术前规划中起着关键作用。
