背景:巨大颅内动脉瘤(GIA)的患者破裂的风险很高,发病率,甚至在手术或血管内治疗后的死亡率。我们描述了一例自发闭塞的GIA,继发于GIA的逐渐生长,持续进展的动脉瘤血栓形成,完整的动脉瘤钙化和完全闭塞的父动脉-右颈内动脉(RICA)。
方法:一名72岁女性患者入院时主诉右眼突然疼痛。她被诊断为GIA[30mm(轴向)×38mm(冠状)×28mm(矢状)],其中包含通过磁共振成像(MRI)诊断的RICA海绵窦段中的动脉瘤血栓,增强MRI,和14年前的磁共振血管造影。稍后,随着海绵状颈动脉GIA的缓慢生长,动脉瘤血栓形成持续进展,RICA的自发闭塞,完整的动脉瘤钙化,GIA逐渐闭塞。她没有蛛网膜下腔出血的病史,但错过了早期血管内治疗的机会。因此,她的右颅神经II受伤留下了严重的永久性后遗症,III,IV,V1/V2和VI。
结论:海绵状颈动脉GIAs破裂的风险相对较低,并且可能由于海绵状颈动脉GIAs的质量效应和极其罕见的动脉瘤钙化引起的母动脉颈内动脉(ICA)的淤滞流和自发闭塞而进一步降低。然而,如今,建议对海绵状颈动脉GIAs进行早期血管内治疗,以防止周围颅内神经损伤和ICA闭塞,主要由海绵样颈动脉GIAs的质量效应引起。
BACKGROUND: Patients with giant intracranial aneurysms (GIAs) are at a high risk of rupture, morbidity, and mortality even after surgical or endovascular treatment. We described a
case of a spontaneously occluded GIA secondary to gradual growth of the GIA, continuously progressed aneurysmal thrombosis, complete aneurysmal calcification and complete occlusion of the parent artery-the right internal carotid artery (RICA).
METHODS: A 72-year-old female patient complained of sudden pain in her right eye upon admission to our hospital. She had been diagnosed with a GIA [30 mm (axial) × 38 mm (coronal) × 28 mm (sagittal)] containing an aneurysmal thrombus located in the cavernous sinus segment of RICA diagnosed by magnetic resonance imaging (MRI), enhanced MRI, and magnetic resonance angiography more than 14 years ago. Later, with slow growth of the cavernous carotid GIA, aneurysmal thrombosis progressed continuously, spontaneous occlusion of the RICA, complete aneurysmal calcification, and occlusion of the GIA occurred gradually. She had no history of subarachnoid hemorrhage but missed the chance for endovascular therapy at an early stage. As a result, she was left with severe permanent sequelae from the injuries to the right cranial nerves II, III, IV, V1/V2, and VI.
CONCLUSIONS: The risk of rupture of the cavernous carotid GIAs was relatively low and possibly further be reduced by the stasis flow and spontaneous occlusion of the parent artery internal carotid artery (ICA) induced by the mass effect of the cavernous carotid GIAs and the extremely rare aneurysmal calcification. However, nowadays, it is advisable to recommend early endovascular treatment for the cavernous carotid GIAs to prevent injuries to the surrounding intracranial nerves and occlusion of the ICA, mainly caused by the mass effect of the cavernous carotid GIAs.