左侧大脑前动脉多发动脉瘤与左额叶血管畸形共存病例报告及文献综述

Multiple Aneurysms of the Left Anterior Cerebral Artery Coexisting with Left Frontal Lobe Vascular Malformations: A Case Report and Review of the Literature

摘要: 本文报告1例56岁男性左侧大脑前动脉多发动脉瘤合并左额叶血管畸形病例。患者因“头痛头晕伴恶心呕吐4天”入院，影像学检查(CT、CTA、全脑血管造影)确诊为左侧大脑前动脉多发动脉瘤(宽颈、形态不规则，直径4~6 mm)合并左额叶血管畸形(直径约5 cm)，并存在颅内动脉瘤破裂伴蛛网膜下腔出血。予一期“颅内多发动脉瘤夹闭 + 血管畸形切除术”治疗，术后恢复良好，术后2月复查无并发症，随访至2025年7月30日未再出血。结合文献分析表明，此类两种血管病变共存的情况临床罕见，其发病与先天性血管发育异常及后天血流动力学异常均可能相关；全脑血管造影(DSA)是诊断金标准，需综合病理机制、影像特征选择手术策略，一期手术可获良好近期预后，但长期预后及发病机制仍需大样本研究进一步阐明。

Abstract: This report describes a case of a 56-year-old male with multiple aneurysms of the left anterior cerebral artery (ACP) combined with a vascular malformation in the left frontal lobe. The patient was admitted for “headache and dizziness with nausea and vomiting for 4 days”. Imaging studies (CT, CTA, whole-brain angiography) confirmed multiple aneurysms of the left anterior cerebral artery (wide-necked, irregularly shaped, 4~6 mm in diameter) combined with a left frontal lobe vascular malformation (approximately 5 cm in diameter), along with a ruptured intracranial aneurysm causing subarachnoid hemorrhage. The patient underwent a single-stage procedure involving “intracranial multiple aneurysm clipping + vascular malformation resection”. Postoperative recovery was uneventful. Follow-up at 2 months showed no complications, and no further hemorrhage was observed through follow-up until July 30, 2025. Literature analysis indicates that the coexistence of these two vascular pathologies is clinically rare, potentially related to both congenital vascular developmental anomalies and acquired hemodynamic abnormalities. Digital subtraction angiography (DSA) serves as the diagnostic gold standard. Surgical strategies should be selected based on a comprehensive assessment of pathological mechanisms and imaging characteristics. Single-stage surgery yields favorable short-term outcomes, though long-term prognosis and underlying pathogenesis require further clarification through large-scale studies.