Sadanaga-Akiyoshi F, Okada Y, Inoue T, Katsuta T, Yasumori K, Ibayashi S, Fujishima M
Department of Neurology, National Kyushu Medical Center Hospital, Fukuoka city, Japan.
Rinsho Shinkeigaku. 2000 Mar;40(3):227-32.
A 65-year-old male complained of loss of consciousness for several minutes, transient diplopia and dizziness. He had no neurological deficits nor abnormalities in MR imaging. However, flow velocity of bilateral vertebral artery on ultrasonography indicated severe stenosis of bilateral distal vertebral artery. Brain angiography revealed severe stenosis of bilateral distal vertebral artery as well as occlusion of right middle cerebral artery (MCA). Single photon emission CT (SPECT: ECD-RVR method with acetazolamide loading) showed decreased cerebral blood flow and poor perfusion reserve in bilateral cerebellar hemisphere and right MCA territory. Superficial temporal artery-superior cerebellar artery (STA-SCA) anastomosis was performed. The patient turned out to have no episodes of unconsciousness attack, transient diplopia and dizziness after operation. Cerebral blood flow (CBF) in the posterior circulation was also improved. Evaluating quantitative CBF measurement by means of ECD-RVR method was useful for evaluating CBF. In cases who have severe stenosis of bilateral distal vertebral artery with complaints of vertebrobasilar insufficiency, STA-SCA anastomosis may be one of the most effective treatments.
一名65岁男性主诉曾有数分钟意识丧失、短暂性复视和头晕。他没有神经功能缺损，磁共振成像也未发现异常。然而，超声检查显示双侧椎动脉血流速度提示双侧椎动脉远端严重狭窄。脑血管造影显示双侧椎动脉远端严重狭窄以及右侧大脑中动脉闭塞。单光子发射计算机断层扫描（SPECT：乙酰唑胺负荷下的ECD-RVR法）显示双侧小脑半球和右侧大脑中动脉供血区脑血流量减少且灌注储备差。进行了颞浅动脉-小脑上动脉（STA-SCA）吻合术。术后患者未再出现意识丧失发作、短暂性复视和头晕。后循环的脑血流量（CBF）也得到改善。通过ECD-RVR法评估定量CBF测量对评估CBF很有用。对于双侧椎动脉远端严重狭窄并伴有椎基底动脉供血不足症状的患者，STA-SCA吻合术可能是最有效的治疗方法之一。
