伴颅内积气的原始三叉动脉动脉瘤血管内治疗一例并文献复习

Endovascular treatment of primitive trigeminal artery aneurysm with pneumocephalus: a case report and literature review

目的分析原始三叉动脉动脉瘤的发生机制、诊断和治疗原则以及发生颅内积气的原因。方法回顾性分析1例伴颅内积气的原始三叉动脉瘤的影像学资料并复习文献。结果头部CT检查见鞍上池、环池、四叠体池积气。CT血管造影(CTA)示左侧颈内动脉床突上段呈局限性突起,大小约21.6 mm×5.1 mm,鞍区扩大,其内显示有团块影,大小约28.6 mm×39.2 mm×34.5 mm,与左侧颈内动脉突起关系密切。在气管插管全身麻醉下,行左侧颈内动脉破裂孔处的原始三叉动脉瘤栓塞术,置入大小不等弹簧圈共17枚。经血管内介入治疗后,患者头痛症状缓解。术后3个月复查头部CT,显示颅内积气大部分被吸收,未出现术后并发症。结论原始三叉动脉瘤伴颅内积气的患者罕见,经CTA和DSA检查可明确诊断,血管内治疗有效并能在短期内使颅内积气减少。

Objective To analyze the pathogenesis, diagnosis and treatment principles of the primitive trigeminal artery aneurysm, as well as the causes of pnenmocephalus in patients. Methods The imaging data of one patient with primitive trigeminal artel7 aneurysm with pneumocephalus were analyzed retrospec- tively and literatures were reviewed. Results Head CT revealed pneumocephalus in suprasellar cistern, ambient cistern, and quadrigeminal cistern. Computed tomography angiography （CTA） showed that a local prominence in the supraclinoid segment of the left internal carotid artery. The volume was about 21.6 mm x 5.1 ram. The sellar region was expanded and it showed a mass shadow in it. The volume was about 28.6 mm x 39.2 mmx 34.5 ram, which was closely associated with the left internal carotid artery promi- nence. Under the general anesthesia , the patient was conducted primitive trigeminal artery aneurysm em- bolization at the left internal carotid artery foramem lacernm seqment. A total of 17 different sizes of coils were implanted. The headache of the patient relieved after endovascular interventional treatment. Head CT at 3 months after surgery showed that most pneumocephalus was absorbed. No postoperative complications occurred. Conclusion Patients with primitive trigeminal artery aneurysm with pneumocephalus are rare. It can be definitely diagnosed with CTA and DSA, and endovascular treatment is effective and can reduce the pneumocephalus within a short-tern.