胶质瘤术后大脑前动脉假性动脉瘤形成的诊治(附1例报告并文献复习)  

Diagnosis and treatment of postoperative pseudoaneurysm of anterior cerebral artery in patient with glioma(case report and review of literature)

作　　者：王在贵[1] 张新元[1] 吕丽辉[1] 杨铭[1] 徐国政[1] 马廉亭[1] 刘征[1] 杨柳[1] 李国栋[1] 伍杰[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10期600-604,共5页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨胶质瘤术后颅内假性动脉瘤形成的临床表现、成因、病理特点、影像学特征、治疗及预后。方法我们收治1例胶质瘤术后大脑前动脉假性动脉瘤形成的33岁女性患者,因鞍区肿瘤行额部经纵裂入路开颅肿瘤切除术,肿瘤大部切除,术后病理检查显示毛细胞星型细胞瘤(WHOⅠ级)。术后12 d,患者突发头痛、恶心呕吐,头部CT检查示术区可见弥散性出血并双侧脑室额角积血,行320-CTA、DSA检查以及3D-DSA与MRI增强影像融合诊断为左侧大脑前动脉A1段假性动脉瘤,利用双微导管技术采用弹簧圈栓塞动脉瘤并孤立局部载瘤动脉。结果术后DSA复查示假性动脉瘤消失,患者恢复良好,无神经系统功能障碍。考虑假性动脉瘤形成原因为肿瘤侵蚀造成血管壁损害、术中大脑前动脉A1段分支血管断裂所致。结论肿瘤术后发生颅内假性动脉瘤罕见,短期内可迅速增大,一旦破裂,死亡率及致残率高。对于颅脑肿瘤包裹血管、术中可能有分支血管损伤,术后术区再出血时,应高度警惕假性动脉瘤形成的可能,一旦发现应选择适当的手术方案进行治疗。ObjectiveTo explore the clinical manifestation, pathological and radiological characteristics, treatment and prognosisof traumatic intracranial pseudoaneurysm after the surgery for glioma.MethodsThe operative region and intraventricular hemorrhageoccurred 12 days after the neurosurgery through cerebral longitudinal fissure for cerebral glioma and the pseudoaneurysm of the firstsection of the left anterior cerebral artery（ACA） was definitely diagnosed by DSA examination in a female patient aged 33 years, inwhom the pseudoaneurysm was treated by the endovascular embolization with coils and wrapping of the parent artery. The literaturerelated to the postoperative pseudoaneurysms was reviewed.ResultsThe postoperative DSA revealed that the pseudoaneurysmdisappeared and the laceration part of the parent artery was occluded. The patient was well recovered without neurological deficit.ConclusionsThe pseudoaneurysm after the surgery for the cerebral glioma is uncommon. The great attention should be paid to thediagnosis and treatment of the pseudoaneurysms because the patient may easily died or be disabled due to the repeated rupture of thepseudoaneurysms. The effect of the endovascular embolization and wrapping of the parent artery on the postoperative pseudoaneurysmsis good.

关 键 词：颅内肿瘤 术后假性动脉瘤 大脑前动脉 诊断 治疗 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R815.2[医药卫生—临床医学]