颅内多发动脉瘤长期随访一例

doi:10.3969/j.issn.1672-6731.2024.08.014

摘要/Abstract

Key words: Intracranial aneurysm, Embolization, therapeutic, Recurrence, Follow-up studies, Case reports

王时强, 何小燕, 耿涛, 彭昌兴. 颅内多发动脉瘤长期随访一例[J]. 中国现代神经疾病杂志, 2024, 24(8): 689-694.

Shi-qiang WANG, Xiao-yan HE, Tao GENG, Chang-xing PENG. Multiple intracranial aneurysms with long-term follow-up: one case report[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(8): 689-694.

https://journal11.magtechjournal.com/cjcnn/CN/Y2024/V24/I8/689

图/表 8

图 1 首次栓塞术前头部横断面CT显示左侧侧裂池积血（箭头所示）

Figure 1 Before the first embolization, axial CT showed hematoma in the left fissure pool (arrow indicates).

图 2 首次栓塞手术前后DSA检查所见 2a 术前正位DSA显示动脉瘤位于左大脑中动脉M2段（2个），体积较大、形态不规则，呈窄颈，考虑为责任动脉瘤（细箭头所示）；以及左颈内动脉C5段动脉瘤（1个），体积较小，形态规则（粗箭头所示） 2b 术后即刻复查正位DSA显示，左大脑中动脉M2段动脉瘤致密栓塞（箭头所示）

Figure 2 DSA findings before and after the first embolization Anteroposterior DSA before embolization showed the 2 aneurysms in the M2 segment of left MCA were large in size and irregular in shape, which were considered as responsible aneurysms with relatively narrow neck (thin arrow indicates), while the aneurysm in the C5 segment of left ICA was small in size and regular in shape (thick arrow indicates, Panel 2a). Anteroposteric DSA immediately after embolization showed complete embolization of left MCA M2 aneurysms (arrow indicates, Panel 2b).

图 3 2015年4月随访影像学检查所见 3a 术前侧位CTA显示左大脑中动脉M2段动脉瘤无复发；左颈内动脉C5段动脉瘤增大，形态改变，呈宽颈（箭头所示） 3b 术中正位DSA显示，采用支架半释放技术栓塞左颈内动脉C5段动脉瘤（箭头所示） 3c 术后即刻正位DSA显示动脉瘤栓塞完全（箭头所示） 3d 术后即刻正位DSA显示大脑前动脉和大脑中动脉血流通畅

Figure 3 Follow-up imaging examination in April 2015 Preoperative lateral CTA showed left MCA M2 aneurysms no signs of recurrence, and left ICA C5 aneurysm with enlarged size, morphological changes and wide neck (arrows indicate, Panel 3a). Embolization of the left ICA C5 aneurysm with stent semi-release technique (arrow indicates, Panel 3b). Postoperative anteroposterior DSA immediately showed complete embolization of the left ICA C5 aneurysm (arrow indicates, Panel 3c). Postoperative anteroposterior DSA immediately showed smooth blood flow in the ACA and MCA (Panel 3d).

图 4 2018年12月随访CTA检查所见 4a 正位CTA显示新发右大脑中动脉M2段和前交通动脉动脉瘤（箭头所示），已栓塞的左大脑中动脉M2段和左颈内动脉C5段动脉瘤无复发 4b 正位CTA显示新发右大脑中动脉M2段和前交通动脉动脉瘤（箭头所示）

Figure 4 Follow-up CTA findings in December 2018 Frontal CTA showed the new right MCA M2 aneurysm and anterior communicating artery aneurysm (arrows indicate), and no signs of recurrence in embolized left MCA M2 aneurysms and left ICA C5 aneurysm (Panel 4a). Frontal CTA showed the right MCA M2 aneurysm and anterior communicating artery aneurysm (arrows indicate, Panel 4b).

图 5 2019年1月随访DSA检查所见 5a 术中正位DSA显示右大脑中动脉M2段动脉瘤（箭头所示） 5b 术中正位DSA显示前交通动脉动脉瘤（箭头所示） 5c 术中正位DSA显示单导管技术栓塞右大脑中动脉M2段动脉瘤（箭头所示） 5d 术中正位DSA显示双导管技术栓塞前交通动脉动脉瘤（箭头所示） 5e 术后即刻正位DSA显示右大脑中动脉M2段动脉瘤栓塞完全（箭头所示）5f术后即刻正位DSA显示前交通动脉动脉瘤栓塞完全（箭头所示）

Figure 5 Follow-up DSA findings in January 2019 Intraoperative anteroposterior DSA showed the right MCA M2 aneurysm (arrow indicates, Panel 5a). Intraoperative anteroposterior DSA showed anterior communicating artery aneurysm (arrow indicates, Panel 5b). Intraoperative anteroposterior DSA showed the right MCA M2 aneurysm was embolized with single catheter technique (arrow indicates, Panel 5c). Intraoperative anteroposterior DSA showed the anterior communicating artery aneurysm was embolized with double catheter technique (arrow indicates, Panel 5d). Postoperative anteroposterior DSA immediately showed complete embolization of the right MCA M2 aneurysm (arrow indicates, Panel 5e). Postoperative anteroposterior DSA immediately showed complete embolization of the anterior communicating artery aneurysm (arrow indicates, Panel 5f).

图 6 2019年4月随访时正位CTA显示左大脑中动脉M2段、左颈内动脉C5段、右大脑中动脉M2段和前交通动脉动脉瘤无复发

Figure 6 Follow-up in April 2019, frontal CTA showed no signs of recurrence in the left MCA M2, left ICA C5, right MCA M2, and anterior communicating artery aneurysms.

图 7 2021年4月随访影像学检查所见 7a 术前正位CTA显示前交通动脉动脉瘤体积增大，提示肿瘤复发（箭头所示） 7b 术前正位DSA显示，右大脑中动脉M2段动脉瘤无复发 7c 术前正位DSA显示，前交通动脉动脉瘤复发（箭头所示），左大脑中动脉M2段和左颈内动脉C5段动脉瘤无复发 7d 术中正位DSA显示单导管技术栓塞前交通动脉动脉瘤（箭头所示） 7e 术后即刻正位DSA显示复发的前交通动脉动脉瘤栓塞完全（箭头所示）

Figure 7 Follow-up imaging findings in April 2021 Frontal CTA before embolization showed increased volume of anterior communicating artery aneurysm, indicating signs of recurrence (arrow indicates, Panel 7a). Anteroposterior DSA before embolization showed no signs of recurrence in the right MCA M2 aneurysm (Panel 7b). Anteroposterior DSA before embolization showed signs of recurrence in the anterior communicating artery aneurysm (arrow indicates), and no signs of recurrence in the left MCA M2 aneurysms and left ICA C5 aneurysm (Panel 7c). Intraoperative anteroposterior DSA showed the anterior communicating artery aneurysm was embolized by single catheter technique (arrow indicates, Panel 7d). Postoperative anteroposterior DSA immediatehy showed the recurrent anterior communicating artery aneurysm was completely embolized (arrow indicates, Panel 7e).

图 8 2022年3月随访复查CTA显示左大脑中动脉M2段、左颈内动脉C5段、右大脑中动脉M2段和前交通动脉动脉瘤无复发 8a 正位CTA 8b 斜位CTA

Figure 8 Follow-up in March 2022 CTA showed no signs of recurrence in the left MCA M2, left ICA C5, right MCA M2, and anterior communicating artery aneurysms. Frontal CTA (Panel 8a). Oblique CTA (Panel 8b).

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