Variant of Persistent Primitive Trigeminal Artery Associated with Giant Internal Carotid Artery Pseudoaneurysm

變異的存續原三叉動脈與巨型偽內頸動脈瘤

林威辰(Wei-Chen Lin) ； 龔國倫(Kuo-Luon Kung) ； 謝文郁(Wen-Yuh Hsieh) ； 劉金昌(Gin-Chung Liu)

《中華放射線醫學雜誌》 26卷4期 (2001/08) Pp. 173-178

摘要

存續性原三叉動脈雖是胚胎腦部血液循環中較常見的一種，但直接與後大腦動脈相連則是較為少見的變異，我們提報了一例有此變異的53歲女性。此外，該患者同時發現有一相當巨大的偽內頸動脈瘤位於內頸動脈的第六節（池節）上，且曾於五年前在他院接受過漢他氏結紮手術。此時因此瘤過大造成視交叉壓迫，外科醫師遂施行移除手術並夾以外科夾；其後因發生廣泛性左前大腦動脈供應區梗塞，並合併敗血症，於六週後導致死亡。這個不幸的經驗強調了最初四條腦血管攝影評估的重要性，且若發現存續的胚胎血液循環而要以外科方法結紮時，應先做氣球測試性堵塞及神經生理監視，以觀察患者是否合適結紮。如不使用傳統外科夾除手術處置，於今日日趨成熟的高尼米可分離式線圈是另一替代性的血管內治療方法。

關鍵字

存續性原三叉動脈 ； 異常的後大腦動脈 ； 偽動脈瘤 ； 漢他氏結紮 ； 高尼米線圈

並列摘要

We report a rare variation of the left persistent primitive trigeminal artery with direct anastomosis with the ipsilateral posterior cerebral artery in a 53-year-old women. She was sent to the hospital with visual deterioration and consciousness disturbance (Glasgow coma scale = E4V3M5). Market hydrocephalus was found. An associated giant pseudoaneurysm was shown arising from the cisternal segment (C6) of the left internal carotid artery (ICA). She received a Hunterian ligation of the left ICA for treatment of the aneurysm in another hospital 5 years previously. The neurosurgeon thereafter removed and clipped the pseudoaneurysm to relieve its mass effect against the optic chiasm. She died of the complication of sepsis following extensive infarction of the territory of the left anterior cerebral artery (ACA) 6 weeks later. This case stresses the significance of careful initial full 4-vessel survey, balloon test occlusion with neurophysiologic monitoring before surgical ligation if fetal circulation is present, and alternative endovascular treatment of the pseudoaneurysm using the GDC (Guglielmi detachable coil) system.

並列關鍵字

Persisten primitive trigeminal artery ； Anomalous posterior cerebral artery ； Pseudoaneurysm ； Hunterian ligation ； Guglielmi detachable coil (GDC)