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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。
Objective To investigate the clinical manifestations, causes, pathological features, imaging features, treatment and prognosis of intracranial pseudoaneurysm after glioma surgery. Methods We treated a 33-year-old woman with anterior cerebral artery pseudoaneurysm after glioma surgery. Because of the sellar segmental craniofacial resection in the sellar region, most of the tumors were removed and the postoperative pathology Examination revealed hair cell astrocytoma (WHO grade). On the 12th day after operation, the patient suffered from sudden headache, nausea and vomiting. The head CT examination showed diffuse hemorrhage and bilateral frontal hemorrhage. The 320-CTA, DSA examination and 3D-DSA and MRI enhanced image fusion were diagnosed as Left anterior cerebral artery occlusion of A1 segment aneurysms, the use of double microcatheter coil coil aneurysm embolization and isolate the local parent artery. Results Postoperative DSA showed false aneurysm disappeared, the patient recovered well without neurological dysfunction. Consider the reasons for the formation of pseudoaneurysm caused by tumor erosion damage to the blood vessel wall, intra-arteries in the anterior segment of the artery due to arterial rupture. Conclusions Intracranial pseudoaneurysm is rare after operation and may increase rapidly in short term. Once ruptured, mortality and morbidity are high. For the brain tumor wrapped blood vessels, surgery may have branch vascular injury, postoperative hemorrhage, should be highly alert to the possibility of the formation of pseudoaneurysm, once found appropriate surgical options should be treated.