Department of Obstetrics and Gynecology, Sawanpracharak Hospital, Nakhon Sawan, Thailand.
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Chiang Mai, Thailand.
BMC Pregnancy Childbirth. 2023 Oct 17;23(1):734. doi: 10.1186/s12884-023-06056-9.
Fetal cerebral aneurysm other than aneurysm of vein of Galen aneurysmal malformation (VGAM) is extremely rare. This report describes prenatal features of aneurysm of the posterior cerebral artery (APCA) with rapid progression and its natural intrauterine course of the disease, which has never been reported.
This is the first report of prenatal features of APCA, detected at 34-36 weeks of gestation, simulating choroid plexus cyst or arachnoid cyst. The diagnosis was based on color flow ultrasound with tracing along the course of cerebral arteries. Also, rendered 3D color flow ultrasound was helpful in demonstrating course of the vessels feeding the aneurysm and supporting the diagnosis. The aneurysm showed nature of rapidly progressive changes, leading to leakage resulting in intracerebral and intraventricular hemorrhage as well as high output state associated with anemia. Prenatal diagnosis and management are very challenging. This case ended up with planned delivery at 37 weeks, giving birth to a surviving male newborn, weighing 2600 g. The neonatal CT brain scans and CTA confirmed the prenatal findings. The prognosis was relatively poor because of extensive intracerebral hemorrhage with severe hydrocephalus and brain midline shift. The couple opted for neonatal palliative care without neurosurgical correction.
This study demonstrate that the most important tool for prenatal diagnosis is color Doppler ultrasound, which will demonstrate turbulent blood flow. Three-dimension color Doppler ultrasound is helpful in supporting the diagnosis. The case presented here suggests that the disease has a natural course of rapid progression and massive brain destruction or high output congestive heart failure can be expected.
除了静脉瘤样畸形（VGAM）的脑动脉瘤外，胎儿脑动脉瘤极为罕见。本报告描述了一种快速进展的大脑后动脉动脉瘤（APCA）的产前特征及其疾病的自然宫内过程，这是从未报道过的。
这是首例产前大脑后动脉动脉瘤的特征报告，在 34-36 孕周时被检测到，模拟脉络丛囊肿或蛛网膜囊肿。该诊断基于彩色血流超声，沿着大脑动脉的走行进行追踪。此外，渲染的 3D 彩色血流超声有助于显示为动脉瘤供血的血管的走行，支持诊断。动脉瘤显示出快速进展变化的特征，导致漏出，引起脑内和脑室内出血以及与贫血相关的高输出状态。产前诊断和管理极具挑战性。本例最终在 37 孕周时计划分娩，生下一名存活的男婴，体重 2600 克。新生儿 CT 脑扫描和 CTA 证实了产前发现。由于广泛的脑内出血、严重的脑积水和大脑中线移位，预后相对较差。夫妇选择新生儿姑息治疗，而不进行神经外科矫正。
本研究表明，产前诊断最重要的工具是彩色多普勒超声，它将显示湍流的血流。三维彩色多普勒超声有助于支持诊断。本病例提示该疾病具有快速进展和大量脑破坏或高输出充血性心力衰竭的自然病程。
