Mizoi K, Yoshimoto T, Takahashi A, Nagamine Y
Department of Neurosurgery, Tohoku University School of Medicine, Japan.
Neurosurgery. 1996 Jul;39(1):165-8; discussion 168-9. doi: 10.1097/00006123-199607000-00035.
This case report details the unexpected surgical difficulty encountered in treating a recurrent aneurysm after coil embolization and presents the histological findings of the resected aneurysm. This is only the second reported case of histological description of an aneurysm after coil embolization in a human.
A 60-year-old woman experienced a 3-month history of chronic headache. Neuroimaging studies demonstrated a 2-cm anterior communicating artery aneurysm. The aneurysm was treated with a two-stage endovascular coil embolization, resulting in almost complete occlusion of the aneurysm. A cerebral angiogram at 6-month follow-up demonstrated slight refilling of the aneurysm, and angiography at 18 months showed a marked increase in the size of the small remnant. Therefore, the patient was referred for direct surgical repair of the aneurysm.
The distal aneurysm dome, which had been packed with the coils and thrombus, was resected under temporary arterial trapping. An intra-aneurysmal endarterectomy was required, because the aneurysm wall developed intimal dissection that extended to the orifices of afferent and efferent arteries. The aneurysm was then obliterated with multiple clips, reconstructing the patent vessel lumen. However, the patient awoke from surgery with left hemiparesis. A postoperative angiogram disclosed occlusion of the right anterior cerebral artery. An histological study of the thrombosed aneurysm showed that the luminal surface of thrombus was not lined by endothelium.
This case demonstrated not only the limited efficacy of coil embolization treatment for wide-necked aneurysms but also the potential difficulty in the direct surgical repair for such recurrent aneurysms.
本病例报告详细阐述了在治疗弹簧圈栓塞术后复发性动脉瘤时意外遇到的手术困难，并展示了切除动脉瘤的组织学发现。这是人类中第二例报告的关于弹簧圈栓塞术后动脉瘤组织学描述的病例。
一名60岁女性有3个月的慢性头痛病史。神经影像学检查显示一个2厘米的前交通动脉瘤。该动脉瘤接受了两阶段血管内弹簧圈栓塞治疗，动脉瘤几乎完全闭塞。6个月随访时的脑血管造影显示动脉瘤有轻微再通，18个月时的血管造影显示小残余瘤体大小显著增加。因此，该患者被转诊进行动脉瘤直接手术修复。
在临时动脉阻断下切除了已被弹簧圈和血栓填充的动脉瘤远端瘤顶。由于动脉瘤壁发生内膜剥离并延伸至出入动脉开口处，需要进行动脉瘤内动脉内膜切除术。然后用多个夹子闭塞动脉瘤，重建通畅的血管腔。然而，患者术后苏醒时出现左半身轻瘫。术后血管造影显示右侧大脑前动脉闭塞。对血栓形成的动脉瘤进行的组织学研究表明，血栓的管腔表面没有内皮细胞覆盖。
本病例不仅显示了弹簧圈栓塞治疗宽颈动脉瘤的疗效有限，还表明了此类复发性动脉瘤直接手术修复的潜在困难。
