Man Ieong-Chon, Pan Tam-Man, U Kuok-Cheong
Department of Radiology, Hospital Conde S. Januário, Macao SAR 999078, China.
World J Clin Cases. 2024 Jul 16;12(20):4337-4347. doi: 10.12998/wjcc.v12.i20.4337.
Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications. Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage. Conversely, basilar artery perforator aneurysms (BAPAs) are a rare etiology. There is no consensus on the optimal management of ruptured BAPAs in the acute setting.
We present a case series of 3 patients with ruptured BAPAs who were treated at our institution. Two patients had a modified Fisher grade of I, and one had a grade of IV on initial presentation. The aneurysms were detected by computed tomography angiography in two cases and conventional angiography in one case. The 3 patients underwent endovascular treatment with Guglielmi detachable coils. Post-treatment, the patients had good clinical outcomes, and follow-up brain computed tomography scans showed reduced subarachnoid hemorrhage without any new hemorrhage. However, one patient experienced a cerebral infarction 2 months later and eventually succumbed to the condition. The other 2 patients showed progressive recovery, and no aneurysm recurrence was observed at the 2-year follow-up.
Endovascular treatment may be a preferable approach for managing ruptured BAPAs compared with surgical intervention or conservative management. Early detection and prompt treatment is important to achieve favorable patient outcomes.
蛛网膜下腔出血是一种严重的神经系统疾病，需要及时且恰当的治疗以预防并发症。动脉瘤是自发性蛛网膜下腔出血最常见的病因。相反，基底动脉穿支动脉瘤（BAPA）是一种罕见的病因。对于急性情况下破裂的BAPA的最佳治疗方法尚无共识。
我们报告了在我院接受治疗的3例破裂BAPA患者的病例系列。2例患者初始表现为改良Fisher分级I级，1例为IV级。2例通过计算机断层扫描血管造影术检测到动脉瘤，1例通过传统血管造影术检测到。这3例患者均接受了使用 Guglielmi 可解脱弹簧圈的血管内治疗。治疗后，患者临床预后良好，随访脑部计算机断层扫描显示蛛网膜下腔出血减少，无新的出血。然而，1例患者在2个月后发生脑梗死，最终死亡。另外2例患者病情逐渐恢复，在2年随访中未观察到动脉瘤复发。
与手术干预或保守治疗相比，血管内治疗可能是治疗破裂BAPA的更优方法。早期发现和及时治疗对于取得良好的患者预后很重要。
