三叉原始动脉动脉瘤一例临床及文献复习

S. Goroshchenko, L. Rozhchenko, V. Bobinov, E. G. Kolomin, A. Petrov
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Also, an “open” surgery produces risks of perforating arteries injury that often extend from trigeminal artery and feed the brain stem, the injury will immediately result in brain ischemic damage. That is why the preferred method for treatment of that kind of pathology may include endovascular intervention both of non‑reconstructive type employing microcoils only and those of reconstructive requiring implantation of assisting or flow‑redirecting stents.Aim. To demonstrate a case of successful treatment of patient with a primitive trigeminal artery aneurysm.Materials and methods. A woman, who was admitted to clinic with complaints of convergent strabismus, undergone surgery for large aneurysm located on primitive trigeminal artery. CT brain angiography revealed large aneurysm of primitive trigeminal artery on the right, the result was later confirmed by data of selective cerebral subtraction angiography. Taking into account oculomotor disorders in the patient, it was decided to refrain from microcoils use due to risk of the mass‑effect preservation. Under double disaggregant therapy (ticagrelor 90 mg twice daily + acetylsalicylic acid 100 mg once daily in the evening) and monitoring the functional activity of platelets, a flow‑deflecting stent was implanted into the right internal carotid artery.Results. The patient was discharged from hospital on the 1st day after the surgery and returned to work. A control angiography performed 3 years later revealed a total shutdown of the aneurysm from bloodstream as well as a partial regression of oculomotor disorders. Intravascular treatment in this situation served as an effective method of choice and made it possible to reliably turn off the aneurysm from bloodstream without impairing the functional outcome of patient’s treatment.Conclusions. 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引用次数: 0

摘要

背景。原始三叉动脉是胚胎发育时期连接颈动脉和椎基底动脉盆地的胎儿吻合口。出生后,在大多数情况下,孩子的动脉闭塞和缩小。有时没有发生闭塞,结果动脉瘤可能在这条动脉上形成(由于颈动脉盆内普通血流动力学的改变),因此,它会产生蛛网膜下腔出血的风险,从而急剧恶化疾病预后。对于这种定位的动脉瘤,通常的显微外科治疗方法用处不大,而且由于颈部的位置非常“低”,手术可能需要延长基底通道,需要切除颅底骨,因此创伤性很大。此外,“开放式”手术会造成动脉穿孔损伤的风险,这些动脉通常从三叉动脉延伸到脑干,这种损伤会立即导致脑缺血损伤。这就是为什么治疗这种病理的首选方法可能包括血管内介入治疗,包括仅使用微线圈的非重建型和需要植入辅助或血流重定向支架的重建型。目的:展示一例成功治疗原发性三叉动脉动脉瘤的病例。材料和方法。一位妇女,谁被承认的会聚斜视的投诉,接受手术大动脉瘤位于原始三叉动脉。CT脑血管造影示右侧大的原始三叉动脉动脉瘤,后经选择性脑减影血管造影资料证实。考虑到患者的动眼病,由于质量效应保存的风险,决定避免使用微线圈。在双重解栓治疗下(替格瑞洛90mg每日2次+乙酰水杨酸100mg每日1次,晚间),监测血小板功能活性,在右侧颈内动脉内植入偏流支架。患者于术后第1天出院,恢复工作。3年后进行的对照血管造影显示动脉瘤从血流中完全关闭,以及眼动肌疾病的部分消退。在这种情况下,血管内治疗是一种有效的选择方法,可以可靠地切断动脉瘤与血液的联系,而不损害患者治疗的功能结果。可以认为,对于此类动脉瘤,血管内介入治疗作为一种微创、低创伤性手术治疗该类病变的有效方法。
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Aneurysm of the primitive trigeminal artery: a clinical case and a literature review
Background. The primitive trigeminal artery is a fetal anastomosis connecting carotid and vertebrobasilar basins during embryonic period of development. After birth, this artery in the child is obliterated and reduced in most cases. Sometimes the obliteration does not occur and as a result the aneurysms may be formed on this artery (due to change in ordinary hemodynamics in carotid basin), as a consequence, it produces a risk of subarachnoid hemorrhage that sharply worsens prognosis of the disease outcome. The usual microsurgical treatment methods of aneurysms of such localization are of little use and are highly traumatic due to the very “low” location of the neck, because the surgery may need extended basal accesses requiring resection of skull base bones. Also, an “open” surgery produces risks of perforating arteries injury that often extend from trigeminal artery and feed the brain stem, the injury will immediately result in brain ischemic damage. That is why the preferred method for treatment of that kind of pathology may include endovascular intervention both of non‑reconstructive type employing microcoils only and those of reconstructive requiring implantation of assisting or flow‑redirecting stents.Aim. To demonstrate a case of successful treatment of patient with a primitive trigeminal artery aneurysm.Materials and methods. A woman, who was admitted to clinic with complaints of convergent strabismus, undergone surgery for large aneurysm located on primitive trigeminal artery. CT brain angiography revealed large aneurysm of primitive trigeminal artery on the right, the result was later confirmed by data of selective cerebral subtraction angiography. Taking into account oculomotor disorders in the patient, it was decided to refrain from microcoils use due to risk of the mass‑effect preservation. Under double disaggregant therapy (ticagrelor 90 mg twice daily + acetylsalicylic acid 100 mg once daily in the evening) and monitoring the functional activity of platelets, a flow‑deflecting stent was implanted into the right internal carotid artery.Results. The patient was discharged from hospital on the 1st day after the surgery and returned to work. A control angiography performed 3 years later revealed a total shutdown of the aneurysm from bloodstream as well as a partial regression of oculomotor disorders. Intravascular treatment in this situation served as an effective method of choice and made it possible to reliably turn off the aneurysm from bloodstream without impairing the functional outcome of patient’s treatment.Conclusions. It can be assumed that intravascular intervention in case of such aneurysms serves as an effective method of choice as minimally invasive and low‑traumatic surgery in the treatment of patients with that type of pathology.
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