Sato Koichiro, Suzuki Kohei, Nakano Yoshiteru, Murakami Yu, Saito Takeshi, Yamamoto Junkoh
Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan.
Surg Neurol Int. 2024 Jun 7;15:189. doi: 10.25259/SNI_308_2024. eCollection 2024.
Perianeurysmal cyst formation after endovascular treatment of cerebral aneurysms is a rare complication; however, the number of reports has gradually increased in recent years due to the development of several endovascular treatments.
We present a case of delayed perianeurysmal cyst enlargement 8 years after endovascular treatment for multiple recurrences of a large cerebral aneurysm in the anterior communicating artery. The patient presented with obstructive hydrocephalus caused by an enlarged perianeurysmal cyst. The patient underwent cyst fenestration using neuroendoscopy and ventriculoperitoneal shunting, recovered from the clinical symptoms, and had a good prognosis. Histopathological findings showed that the cyst wall contained a fibrotic layer under the monoependymal layer with hemosiderosis without evidence of neovascularization or inflammatory cell infiltration. These findings suggest that the origin of the perianeurysmal cyst wall is not the aneurysm itself but the adjacent brain tissue.
Perianeurysmal cysts can develop during long-term follow-up, and clinicians should consider surgical treatment, including cyst fenestration, using neuro-endoscopy if the cyst presents with clinical symptoms.
脑动脉瘤血管内治疗后瘤周囊肿形成是一种罕见的并发症；然而，近年来由于多种血管内治疗方法的发展，相关报道数量逐渐增加。
我们报告一例大脑前交通动脉大型动脉瘤多次复发后行血管内治疗8年后出现延迟性瘤周囊肿扩大的病例。患者因瘤周囊肿扩大导致梗阻性脑积水。患者接受了神经内镜下囊肿开窗术和脑室腹腔分流术，临床症状缓解，预后良好。组织病理学检查结果显示，囊肿壁在单层室管膜层下有一层纤维化层，伴有含铁血黄素沉着，无新生血管形成或炎症细胞浸润迹象。这些结果表明，瘤周囊肿壁并非起源于动脉瘤本身，而是起源于邻近脑组织。
瘤周囊肿可在长期随访过程中发生，若囊肿出现临床症状，临床医生应考虑手术治疗，包括使用神经内镜进行囊肿开窗术。
