抄録
A few cases of ruptured intracranial aneurysms associated with pulseless disease have been reported previously. In such cases the aneurysms arose on the cerebral arteries serving as collateral pathways. The role of hemodynamic factors in the pathogenesis of these aneurysms has been emphasized.
In this paper, we report three cases of ruptured intracranial saccular aneurysms associated with pulseless disease.
Case 1: A 54 year-old woman had three episodes of subarachnoid hemorrhage 15 years, four years, and one year previously. Right vertebro-angiograms showed a giant aneurysm at the terminal bifurcation of the basilar artery. She died during the operation.
Case 2: A 55 year-old man had a sudden attack of severe occipital headaches due to a subarachnoid hemorrhage. Right vertebro-angiograms revealed an intracranial aneurysm located at the junction of the right vertebral-posterior inferior cerebellar artery. Aneurysmal neck clipping was performed via the right suboccipital approach.
Case 3: A 64 year-old woman had severe headaches and motor weakness in both legs. Left carotid angiograms revealed multiple intracranial aneurysms (at the junction of the left IC-Ophth and IC-PC arteries, and at the top of the basilar artery). She died due to bleeding from the basilar top aneurysm. In addition to the three intracranial saccular aneurysms discovered by arteriography, autopsy revealed another small saccular aneurysm at the junction of the basilar and left anterior inferior cerebellar arteries.
Surgical treatment for ruptured saccular aneurysms associated with pulseless disease should be carried out insofar as the patient's general condition allows for the operation. In some cases, reconstruction of the artery may be helpful for the relief of cerebral ischemic symptoms.
