Occipital Artery-Anterior Inferior Cerebellar Artery Bypass With Microsurgical Trapping for Exclusively Intra-meatal Anterior Inferior Cerebellar Artery Aneurysm Manifesting as Subarachnoid Hemorrhage -Case Report-
Occipital Artery-Anterior Inferior Cerebellar Artery Bypass With Microsurgical Trapping for Exclusively Intra-meatal Anterior Inferior Cerebellar Artery Aneurysm Manifesting as Subarachnoid Hemorrhage -Case Report-
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DOI：
10.2176/nmc.52.435
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发表时间：
2012-06-01
影响因子：
1.9
通讯作者：
Tominaga, Teiji
中科院分区：
文献类型：
--
作者：
Fujimura, Miki;Inoue, Takashi;Tominaga, Teiji
一名 77 岁女性患有极其罕见的完全肉内小脑前下动脉 (AICA) 动脉瘤，表现为蛛网膜下腔出血。动脉瘤位于其耳道的非分支部位，在内耳道深处。同侧小脑后下动脉发育不全，受影响的 AICA 为右侧小脑提供了广泛的血管区域。患者在急性期接受了远端 AICA 动脉瘤的显微手术捕获。载瘤动脉的侧支回流较差，因此在动脉瘤捕获之前进行右枕动脉 (OA)-AICA 吻合术。术后过程平安无事，术后磁共振成像未显示任何缺血性改变。术后血管造影显示 AICA 动脉瘤完全消失，并且 OA-AICA 旁路明显专利。除了右侧不完全听力障碍外，她没有出现神经功能障碍，术后单光子发射计算机断层扫描显示小脑没有血流动力学损害。 OA-AICA 动脉瘤吻合术可能是仅位于内耳道内的 AICA 动脉瘤的最佳手术治疗方法，特别是在载瘤动脉供应广泛的血管区域的情况下。
A 77-year-old woman presented with an extremely rare exclusively intra-meatal anterior inferior cerebellar artery (AICA) aneurysm manifesting as subarachnoid hemorrhage. The aneurysm was located at a non-branching site of its meatal loop, deeply inside the internal auditory canal. The ipsilateral posterior inferior cerebellar artery was hypoplastic and the affected AICA supplied a wide vascular territory in the right cerebellum. The patient underwent microsurgical trapping of the distal AICA aneurysm in the acute stage. Collateral back flow to the parent artery was poor, so right occipital artery (OA)-AICA anastomosis was performed prior to aneurysm trapping. The postoperative course was uneventful, and magnetic resonance imaging after surgery did not demonstrate any ischemic change. Postoperative angiography showed complete disappearance of the AICA aneurysm and the apparently patent OA-AICA bypass. She did not suffer neurological deficit except for right incomplete hearing disturbance, and postoperative single photon emission computed tomography demonstrated absence of hemodynamic compromise in the cerebellum. OA-AICA anastomosis with aneurysm trapping could be the optimal surgical management of the AICA aneurysm located exclusively inside the internal auditory canal, especially if the parent artery supplies a wide vascular territory.