Nishizawa S, Yokoyama T, Sugiyama K, Yokota N
Department of Neurosurgery, Hamamatsu University School of Medicine, Shizuoka.
Neurol Med Chir (Tokyo). 2000 Aug;40(8):408-12. doi: 10.2176/nmc.40.408.
A 43-year-old hypertensive male developed a pseudoaneurysm at the site of a superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis, causing massive intracerebral hemorrhage 5 years after the operation. He first experienced repeated transient ischemic attacks, and cerebral angiography disclosed complete occlusion in the cervical portion of the left internal carotid artery. STA-MCA anastomosis was performed, and the ischemic attacks stopped. Postoperative angiography confirmed patency of the anastomosis and good filling of the cortical branches of the left MCA. Five years after surgery, the patient suffered sudden onset of generalized convulsions and consciousness disturbance. Computed tomography disclosed a massive intracerebral hemorrhage in the left frontoparietal region, and angiography revealed an aneurysmal dilatation at the site of the anastomosis that was not seen before. Emergency evacuation of the hematoma and clipping of the aneurysmal dilatation were performed. The patient recovered well and became ambulatory. Histological examination of the surgical specimen showed collagen tissue, indicating a pseudoaneurysm. Patients who undergo STA-MCA anastomosis, especially hypertensive patients, should be followed up by repeated magnetic resonance angiography to confirm the patency of the anastomosis and cerebral perfusion, and to detect the formation of pseudoaneurysms at the anastomosis site, which can cause fatal bleeding.
一名43岁的高血压男性在颞浅动脉（STA）-大脑中动脉（MCA）吻合处出现假性动脉瘤，术后5年导致大量脑出血。他最初反复出现短暂性脑缺血发作，脑血管造影显示左颈内动脉颈部完全闭塞。进行了STA-MCA吻合术，缺血发作停止。术后血管造影证实吻合口通畅，左MCA皮质分支充盈良好。术后5年，患者突然出现全身性抽搐和意识障碍。计算机断层扫描显示左额顶叶区域大量脑出血，血管造影显示吻合处有动脉瘤样扩张，之前未见。进行了紧急血肿清除和动脉瘤样扩张夹闭术。患者恢复良好，能够行走。手术标本的组织学检查显示为胶原组织，提示假性动脉瘤。接受STA-MCA吻合术的患者，尤其是高血压患者，应通过反复磁共振血管造影进行随访，以确认吻合口通畅和脑灌注情况，并检测吻合口处假性动脉瘤的形成，其可导致致命性出血。
