利用血流导向装置治疗大型原始三叉动脉动脉瘤一例并文献复习

Treatment of large persistent primitive trigeminal artery aneurysm with blood flow diverter:a case report and literature review

目的报道利用密网孔血流导向装置(FD)治疗1例大型原始三叉动脉(PPTA)动脉瘤的病例。方法回顾性分析2018年12月在暨南大学附属第一医院神经外科住院的1例伴外展神经及动眼神经不全损害的大型PPTA动脉瘤的54岁女性患者单用FD治疗前后的影像学及临床资料,并复习相关文献。结果数字减影血管造影(DSA)提示左侧PPTA未闭,颈内动脉通过PPTA与基底动脉相交通,动脉瘤位于PPTA的起始部,大小约18.41 mm×12.80 mm。在颈内动脉海绵窦段植入FD后动脉瘤内造影剂明显滞留。术后8个月复诊左侧眼睑下垂消失,复视消失,眼球活动正常;复查DSA示PPTA处动脉瘤基本未见明显显影。结论对于成熟型的PPTA相关的大型或巨大型动脉瘤,FD治疗可能是一种较好的治疗方法。

Objective To report a case of large persistent primitive trigeminal artery aneurysm treated with dense reticular blood flow guide device (flow diverter, FD).Methods The imaging and clinical data before and after treatment with FD of a 54 years old female patient with large persistent primitive trigeminal artery aneurysm with abducent nerve and oculomotor nerve insufficiency in the Department of Neurosurgery, the First Affiliated Hospital of Jinan University in December 2018 were analyzed retrospectively, and the related literature was reviewed.Results Digital subtraction angiography (DSA) showed that the left primitive trigeminal artery was not closed, and the internal carotid artery communicated with the basilar artery through the original trigeminal artery. The aneurysm was located at the beginning of the original trigeminal artery and the size was about 18.41 mm×12.8 mm. The contrast agent in the aneurysm was significantly retained after the cavernous sinus segment of the internal carotid artery was implanted with FD. Eight months after operation, the left blepharoptosis disappeared, strabismus disappeared and eyeball movement was normal. DSA showed that there was no obvious development of aneurysm in the original trigeminal artery.Conclusion For mature persistent primitive trigeminal artery related large or giant aneurysm, FD may be a better means of treatment.