Surgical Clipping of a Basilar Perforator Artery Aneurysm: A Case of Avoiding Perforator Sacrifice
Surgical Clipping of a Basilar Perforator Artery Aneurysm: A Case of Avoiding Perforator Sacrifice
复制标题
基底穿支动脉瘤的手术夹闭：避免穿支牺牲的一个案例
DOI：
10.1055/s-0033-1356488
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
S. Agazzi
中科院分区：
文献类型：
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作者：
S. Sivakanthan;A. Carlson;H. van Loveren;S. Agazzi
摘要背景基底动脉穿支动脉瘤是非常罕见的。 手术的主要目标始终是保留交通支血流。然而，在文献中的大多数手术治疗病例中，报告了交通支牺牲。重要的是，文献应证明交通支血管通畅是一个可实现的目标。目的介绍第二例基底动脉交通支动脉瘤手术中保留交通支血流的病例。 一位45岁的女性，患有世界神经外科医师联合会1级蛛网膜下腔出血。数字减影血管造影最终显示一个2毫米的动脉瘤的基底动脉起源于一个穿支后，最初的阴性血管造影。在直接检查和术中血管造影证实交通支通畅的情况下进行夹闭。患者的术后病程顺利，术后磁共振成像（MRI）显示无脑干卒中证据。结论尽管交通支的通畅是脑血管手术的一个相当明显的目标，但目前的文献并没有反映出在基底动脉交通支动脉瘤的情况下能够做到这一点。 我们提出的第二个报告的情况下，维持交通支血流夹闭后的基底动脉交通支动脉瘤。
Abstract Background Aneurysms arising from basilar perforator arteries are very rare. A primary goal of surgery is always preservation of perforator flow. However, in most surgically managed cases in the literature, sacrifice of the perforator was reported. It is important for the literature to demonstrate that patency of the perforator is an achievable goal. Objective To present the second reported case of perforator flow preservation in the surgical management of basilar perforator artery aneurysms. Clinical Presentation A 45-year-old woman presented with World Federation of Neurologic Surgeons grade 1 subarachnoid hemorrhage. Digital subtraction angiography ultimately revealed a 2-mm aneurysm of the basilar artery arising from a perforator after an initially negative angiogram. Clipping was performed with perforator patency confirmed on direct inspection and intraoperative angiography. The patient's postoperative course was uneventful, and postoperative magnetic resonance imaging (MRI) showed no evidence of brainstem stroke. Conclusion Although patency of the perforator is a rather obvious goal of cerebrovascular surgery, the current literature does not reflect an ability to do so in the case of basilar perforator aneurysms. We present only the second reported case of maintenance of perforator flow after clipping of a basilar perforator artery aneurysm.