Zubkov Y N, Matsko D E, Pak V A
Department of Cerebral Vascular Surgery, A.L. Polenov Russian Neurosurgical Institute, St. Petersburg.
Neurosurgery. 1998 Mar;42(3):664-6. doi: 10.1097/00006123-199803000-00043.
A rare observation of double saccular aneurysms of the meningeal artery is presented.
This 22-year-old man was referred to the Neurosurgical Institute with a suspicion of an aneurysm of the anterior communicating artery. Bilateral angiography of the carotid arteries was performed 1 week after the subarachnoid hemorrhage, but the aneurysms were not visualized. Routine angiography of both carotid arteries and selective studies of the left vertebral artery were performed again, and angiography of the right carotid artery revealed an aneurysm. The patient's neurological state at the time of admission was normal. Fundoscopic examination revealed papilledema and conjunctival injection of the left eye.
The patient was treated using a right pterional approach. One aneurysm had caused spontaneous subarachnoid hemorrhage. The aneurysms were removed using a direct approach, with histological examination of dura matter fragment containing both aneurysms. The results of the patient's 2-week follow-up examination were normal. Follow-up angiography of the right carotid artery showed absence of the aneurysm with a clip on the branch of meningeal artery.
Saccular aneurysms of the meningeal artery can be manifested by subarachnoid hemorrhage, and intradural arterial aneurysms are similar to saccular cerebral vessel lesions structurally.
本文报道了一例罕见的脑膜动脉双囊状动脉瘤。
这名22岁男性因怀疑前交通动脉瘤被转诊至神经外科研究所。蛛网膜下腔出血1周后进行了双侧颈动脉血管造影，但未发现动脉瘤。再次对双侧颈动脉进行常规血管造影并对左椎动脉进行选择性研究，右侧颈动脉血管造影显示一个动脉瘤。患者入院时神经状态正常。眼底检查发现左眼视乳头水肿和结膜充血。
患者采用右侧翼点入路进行治疗。一个动脉瘤已导致自发性蛛网膜下腔出血。采用直接入路切除动脉瘤，并对包含两个动脉瘤的硬脑膜碎片进行组织学检查。患者2周的随访检查结果正常。右侧颈动脉的随访血管造影显示动脉瘤消失，脑膜动脉分支处有夹子。
脑膜动脉囊状动脉瘤可表现为蛛网膜下腔出血，硬膜内动脉动脉瘤在结构上与囊状脑血管病变相似。
