Takeuchi Youhei, Yoshida Masahiro, Nishijima Yasuo, Niizuma Kuniyasu, Endo Hidenori
Department of Neurosurgery, Osaki Citizen Hospital, Oosaki, Miyagi, Japan.
Preemptive Medicine in the Community of the North Miyagi, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
NMC Case Rep J. 2025 Apr 25;12:167-173. doi: 10.2176/jns-nmc.2024-0252. eCollection 2025.
Partially thrombosed and dissecting giant peripheral aneurysms present significant challenges for treatment with both direct surgical and endovascular approaches. We report a case of partially thrombosed, dissecting giant aneurysm in the peripheral segment of the middle cerebral artery treated with straightforward endovascular parent artery occlusion without saccular packing. A 30-year-old male presented with sudden loss of consciousness and subarachnoid hemorrhage and was transferred to our hospital. On admission, his level of consciousness was assessed as Japan Coma Scale 100 and Glasgow Coma Scale 8 (E1V2M5), with severe paralysis of the right upper and lower limbs. Computed tomography and magnetic resonance imaging demonstrated a partially thrombosed middle cerebral artery aneurysm with a maximum diameter of 31 mm at the M2 non-branching segment of the left middle cerebral artery mid-trunk. Cerebral angiography indicated potential collateral circulation, no retrograde opacification of the aneurysm, and absence of perforating branches near the lesion, so we selected endovascular parent artery occlusion that targeted only the proximal portion of the aneurysm. Postoperative care focused on managing intracranial pressure and overall systemic management. The patient recovered without significant infarction and was discharged home with a modified Rankin Scale score of 1 4 months after the onset. In general, peripheral aneurysms are less likely to cause perforator infarcts, and larger aneurysms are more tolerant of parent artery occlusion. Therefore, simple endovascular parent artery occlusion targeting only the proximal portion of the aneurysm offers both anatomical and pathophysiological advantages and provides a viable option when direct surgery is challenging.
部分血栓形成且夹层的巨大外周动脉瘤对直接手术和血管内治疗方法都构成了重大挑战。我们报告一例大脑中动脉外周段部分血栓形成、夹层的巨大动脉瘤，采用单纯血管内闭塞载瘤动脉而不进行瘤囊填塞治疗。一名30岁男性因突发意识丧失和蛛网膜下腔出血被转诊至我院。入院时，其意识水平按日本昏迷量表评分为100分，格拉斯哥昏迷量表评分为8分（E1V2M5），右上肢和下肢严重瘫痪。计算机断层扫描和磁共振成像显示左侧大脑中动脉主干M2非分支段有一个最大直径为31mm的部分血栓形成的大脑中动脉动脉瘤。脑血管造影显示有潜在的侧支循环，动脉瘤无逆行显影，病变附近无穿支，因此我们选择仅针对动脉瘤近端的血管内载瘤动脉闭塞术。术后护理重点是控制颅内压和进行全面的全身管理。患者恢复良好，无明显梗死，发病4个月后改良Rankin量表评分为1分出院。一般来说，外周动脉瘤较少引起穿支梗死，较大的动脉瘤对载瘤动脉闭塞的耐受性更强。因此，仅针对动脉瘤近端的单纯血管内载瘤动脉闭塞术具有解剖学和病理生理学优势，在直接手术具有挑战性时提供了一种可行的选择。
