Broekx Senne, Keulen Lotte, Menovsky Tomas
Department of Neurosurgery, Antwerp University Hospital, 2650, Edegem, Belgium.
Department of Pathology, Antwerp University Hospital, 2650, Edegem, Belgium.
Brain Spine. 2023 Jul 26;3:101786. doi: 10.1016/j.bas.2023.101786. eCollection 2023.
Aneurysm mimics, such as an occluded cerebral artery, vascular loops or infundibular dilatations, should be beard in mind when planning a craniotomy for the treatment of an aneurysm. Although ischemic stroke caused by clot migration from an aneurysmal cavity has been described, an ischemic event should raise awareness of potential MCA branch occlusion instead of an aneurysm.
We provided a scaffold that could be used to differentiate other saccular aneurysm mimics. We explored the current literature concerning ACM segment occlusions initially misdiagnosed as a saccular aneurysm.
We present the case of a 58 year old female who experienced a subarachnoid hemorrhage. CT angiography could not reveal an underlying aneurysm. She had a medical history of right carotid artery occlusion with secondary ischemic stroke and left spastic hemiparesis. An aneurysm of the right MCA was suspected and she was scheduled for explorative craniotomy.
Peroperatively we did not encounter an aneurysm, although a thrombosed branch of the right MCA was noted. The most proximal part of the branch was still patent, mimicking a saccular aneurysm on angiographic records.
Aneurysm mimics can potentially expose patients to unnecessary exploratory craniotomies in the presumptive diagnosis of a saccular aneurysm. MRI 3D-CISS can be a helpful adjunct, since MRA and DSA are frequently not sufficient. Although ischemic stroke can be caused by clot migration from an aneurysmal cavity, an ischemic event should raise awareness of potential cerebral artery occlusion.
在计划开颅手术治疗动脉瘤时，应考虑到动脉瘤的模仿病变，如闭塞的脑动脉、血管袢或漏斗状扩张。虽然已经描述了由动脉瘤腔内血栓迁移引起的缺血性中风，但缺血事件应提高对潜在大脑中动脉分支闭塞而非动脉瘤的认识。
我们提供了一种可用于区分其他囊状动脉瘤模仿病变的框架。我们探讨了当前有关最初被误诊为囊状动脉瘤的大脑中动脉（MCA）节段闭塞的文献。
我们报告了一名58岁女性蛛网膜下腔出血的病例。CT血管造影未能发现潜在的动脉瘤。她有右侧颈动脉闭塞继发缺血性中风和左侧痉挛性偏瘫的病史。怀疑右侧大脑中动脉有动脉瘤，她被安排进行 exploratory craniotomy（此处原文有误，推测应为“exploratory craniotomy”，意为“ exploratory craniotomy”，意为“探索性开颅手术”）。
手术中我们未发现动脉瘤，尽管注意到右侧大脑中动脉的一个血栓形成分支。该分支最近端部分仍通畅，在血管造影记录上类似囊状动脉瘤。
在囊状动脉瘤的推定诊断中，动脉瘤模仿病变可能会使患者面临不必要的探索性开颅手术。MRI 3D-CISS可能是一种有用的辅助手段，因为MRA和DSA常常不够充分。虽然缺血性中风可由动脉瘤腔内血栓迁移引起，但缺血事件应提高对潜在脑动脉闭塞的认识。
