Infante-Cossío P, García-Perla A, González-García A, Gil-Peralta A, Gutiérrez-Pérez J L
Servicio de Cirugía Oral y Maxilofacial, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain.
Rev Neurol. 2004;39(4):339-43.
Elongation of the styloid process has been reported as a source of pain in the head and neck region. However, transient ischemic attack (TIA) due to mechanical compression of the internal carotid artery (ICA) by an elongated styloid process has never been mentioned in the literature.
Male aged 36 years, with a ten-year history of dull intermittent pain in the left side of the neck that worsened on turning the head, suffered a TIA in the silvian territory, ten days after a minor neck trauma. The eco-Doppler exploration demonstrated a compression of the ICA after rotation of the head. The arteriography revealed an stenosis of the cervical ICA by an external compression. The length of the elongated process in the orthopantomogram and the computed tomography was 35 mm. Angiotomography showed a closed relationship between the tip of the left elongated process and the stenosis of the ICA. Surgical styloidectomy was performed via an extraoral approach under general anaesthesia. The excised specimen measured 30 mm long. All symptoms were relieved with no recurrence during a three-year follow up period.
TIA should be taken into account in the clinical feature associated to an elongated styloid process. Angiotomography is very reliable to define the anatomic relationship between the styloid process and the ICA. The treatment of choice is surgical shortening trough an external approach which provides an adequate control of the carotid artery.
茎突过长已被报道为头颈部疼痛的一个原因。然而，文献中从未提及过长的茎突对内颈动脉（ICA）的机械性压迫导致短暂性脑缺血发作（TIA）。
一名36岁男性，有左侧颈部钝性间歇性疼痛10年病史，转头时疼痛加重，在一次轻微颈部外伤后10天，在大脑外侧裂区发生TIA。超声多普勒检查显示转头后ICA受压。血管造影显示颈段ICA存在外部压迫导致的狭窄。全景曲面断层片和计算机断层扫描显示过长茎突的长度为35毫米。血管断层造影显示左侧过长茎突尖端与ICA狭窄之间存在密切关系。在全身麻醉下通过口外入路进行了茎突切除术。切除的标本长30毫米。在三年的随访期内，所有症状均缓解且无复发。
在与茎突过长相关的临床特征中应考虑TIA。血管断层造影对于确定茎突与ICA之间的解剖关系非常可靠。首选的治疗方法是通过外部入路进行手术缩短，这样可以充分控制颈动脉。
