两次DSA阴性的颅内破裂动脉瘤1例报道并文献复习  

Both negative DSA findings in 1 patient with ruptured intracranial aneurysm(case report and review of literature)

作　　者：祝源[1] 李俊[1] 陈刚[1] 向伟楚[1] 李国栋[1] 赵曰圆[1] 李欢欢[1] 汤伟[1] 金二亮 马廉亭[1] 

机构地区：[1]广州军区武汉总医院神经外科,武汉430070

出　　处：《中国临床神经外科杂志》2015年第9期538-540,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的报告1例经两次全脑、全程血管造影阴性的破裂小脑后下动脉动脉瘤患者诊治经验。方法回顾性分析1例颅内破裂动脉瘤病人的临床资料,包括症状、体征、影像学检查、手术过程及病理结果,分析其脑血管造影阴性的原因。结果患者为21岁男性,以突发头痛起病,外院头部CT示蛛网膜下腔出血,但脑血管造影未发现动脉瘤,头部MRI检查怀疑脑干背侧海绵状血管瘤。转入我院后,复查全脑、全程血管造影仍然为阴性,复查头部MRI检查再次怀疑海绵状血管瘤并行开颅手术治疗,术中于小脑延髓裂发现病变为豌豆大小。呈结节状,有供血动脉进入口和输出口,术后病理证实为动脉瘤内血栓形成并机化。术后病人恢复良好。将MRI影像与3D-DSA影融合后,发现病变旁有小脑后下动脉通过,考虑为动脉瘤出血后继发血栓形成而闭塞。结论脑血管造影虽然是颅内动脉瘤诊断的金标准,但是两次脑血管造影阴性仍然不能完全排除颅内动脉瘤,其中原因之一就是动脉瘤出血后继发血栓形成。Objective To summarize the experience in diagnosing and treating a ruptured inferior cerebellar artery aneurysm which was not found by two examinations of DSA. Methods The clinical data of 1 patient with intracranial aneurysm, which was not found by two examinations of DSA, were analyzed retrospectively, including the clinical manifestations, imaging data, operative process and pathological data. Results A 21-year-old male patient was presented with sudden headache. CT revealed subarachnoid hemorrhage, and the initial cerebral angiography found no aneurysm in the patient, who be resuspected of cavernous hemangioma in the dorsal brainstem by MRI. The patient was transferred to our hospital, and second the cerebral angiography was performed. The pan-angiography was technically adequate and showed aneurysmal non-visualization. The cavernous hemangioma was suspected again by MRI in the patient, in whom surgery was performed. The bean-like size lesion was found in the cerebellomedullary fissure by the operation. The lesion was removed and pathologically confirmed to be intravascular thrombosis. The patient was recovered well without neurological deficit. Retrospectively, 3D-DSA and MRI image fusion, which were attained through Inspace3D-3D-Fusion software （Sienmens System Syngo X-WP）, showed that the posterior inferior cerebellar artery passed by the nodular lesion. It is highly likely that the aneurysmal spontaneous occlusion occurred after the rupture. Conclusions The cerebral angiography is the gold standard for the diagnosis of intracranial aneurysm, but the diagnosis of intracranial aneurysm could not be completely excluded by repeated negative cerebral angiography because the intraaneurysmal secondary thrombosis after the aneurismal rupture may interfere with the visualization of the aneurysm.

关 键 词：颅内动脉瘤 蛛网膜下腔出血 脑血管造影 阴性 瘤内血栓形成 显微手术 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]