Toader Corneliu, Radoi Mugurel Petrinel, Brehar Felix-Mircea, Serban Matei, Glavan Luca-Andrei, Covache-Busuioc Razvan-Adrian, Ciurea Alexandru Vlad, Dobrin Nicolae
Department of Neurosurgery "Carol Davila", University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania.
J Clin Med. 2024 Nov 8;13(22):6719. doi: 10.3390/jcm13226719.
Pericallosal artery aneurysms are rare, accounting for 2-9% of all intracranial aneurysms, and mirror aneurysms in this location are exceptionally uncommon, presenting unique surgical challenges due to their deep location and proximity to critical neurovascular structures. The aim of this case report is to describe the surgical management and successful outcome of a patient with mirror pericallosal artery aneurysms and to contribute insights into the clinical and surgical considerations for this rare condition. We report the case of a 71-year-old female with multiple cardiovascular and metabolic conditions, including hypertension and smoking-well-established risk factors for intracranial aneurysm formation and rupture. She presented with a Hunt and Hess grade II subarachnoid hemorrhage resulting in communicating internal hydrocephalus. Preoperative angiography revealed mirror aneurysms of the pericallosal artery. The patient underwent a left basal paramedian frontal craniotomy, during which a ruptured aneurysm on the right A2 segment and an unruptured aneurysm on the left A2 segment were identified. Both aneurysms were successfully clipped using curved Yasargil clips. Postoperative recovery was favorable, with no neurological deficits and stable imaging findings at a three-month follow-up. This case underscores the necessity for precise microsurgical intervention and a thorough understanding of pericallosal artery anatomy to manage such rare and challenging conditions effectively. The role of hyperlipidemia and statin use in intracranial aneurysm development remains debated and warrants further investigation. Our successful management of mirror pericallosal artery aneurysms contributes to the limited literature on this rare condition and highlights the importance of meticulous surgical techniques for favorable outcomes.
胼周动脉瘤较为罕见，占所有颅内动脉瘤的2% - 9%，而该部位的镜像动脉瘤尤为少见，因其位置深且靠近关键神经血管结构，给手术带来了独特挑战。本病例报告旨在描述一名患有镜像胼周动脉瘤患者的手术治疗及成功结果，并为这种罕见病症的临床和手术考量提供见解。我们报告一例71岁女性患者，患有多种心血管和代谢疾病，包括高血压和吸烟，这些都是颅内动脉瘤形成和破裂的公认危险因素。她因Hunt和Hess分级II级蛛网膜下腔出血导致交通性脑积水。术前血管造影显示胼周动脉镜像动脉瘤。患者接受了左侧基底旁正中前额开颅手术，术中发现右侧A2段有一个破裂动脉瘤和左侧A2段有一个未破裂动脉瘤。使用弯曲的Yasargil夹成功夹闭了两个动脉瘤。术后恢复良好，三个月随访时无神经功能缺损，影像学检查结果稳定。该病例强调了精确的显微手术干预以及对胼周动脉解剖结构的透彻理解对于有效处理此类罕见且具有挑战性病症的必要性。高脂血症和他汀类药物在颅内动脉瘤发生中的作用仍存在争议，值得进一步研究。我们对镜像胼周动脉瘤的成功治疗丰富了关于这种罕见病症的有限文献，并突出了精细手术技术对取得良好结果的重要性。
