Nomura M, Kida S, Kita D, Kaneko T, Higashi R, Yoshikawa J, Matsui O, Yamashita J
Department of Neurosurgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Japan.
Surg Neurol. 2000 Mar;53(3):239-42. doi: 10.1016/s0090-3019(99)00191-3.
We present a case of ruptured vertebral dissecting aneurysm that exhibited cerebellar hemorrhage after successful embolization of the vertebral artery including the dissected site.
A 59-year-old man suffered a sudden onset of severe occipital headache when he looked up. Computed tomography demonstrated subarachnoid hemorrhage. Angiography revealed a right vertebral dissecting aneurysm distal to the posterior inferior cerebellar artery. Endovascular embolization of the aneurysm was performed with preservation of the posterior inferior cerebellar artery. The next day, the patient suffered a cerebellar hemorrhage in the vermis. The intracranial pressure was controlled by external ventricular drainage. The patient was discharged with mild cerebellar ataxia and bilateral abducens nerve palsy.
In a case of vertebral dissecting aneurysm distal to the posterior inferior cerebellar artery, blood circulation in the vertebral arterial system may change after embolization of the aneurysm. In our case, the preserved posterior inferior cerebellar artery might have been hemodynamically stressed postoperatively, resulting in cerebellar hemorrhage. Therefore, strict control of blood pressure is essential in the acute stage after occlusion of the aneurysm.
我们报告一例椎动脉夹层动脉瘤破裂病例，该病例在成功栓塞包括夹层部位的椎动脉后出现小脑出血。
一名59岁男性在抬头时突然出现严重枕部头痛。计算机断层扫描显示蛛网膜下腔出血。血管造影显示小脑后下动脉远端右侧椎动脉夹层动脉瘤。在保留小脑后下动脉的情况下对动脉瘤进行了血管内栓塞。第二天，患者蚓部出现小脑出血。通过外部脑室引流控制颅内压。患者出院时伴有轻度小脑共济失调和双侧展神经麻痹。
对于小脑后下动脉远端的椎动脉夹层动脉瘤病例，动脉瘤栓塞后椎动脉系统的血液循环可能发生改变。在我们的病例中，保留的小脑后下动脉术后可能受到血流动力学压力，导致小脑出血。因此，动脉瘤闭塞后的急性期严格控制血压至关重要。
