Matsui Toru, Taniguchi Tamiki, Saitoh Tatsuya, Kamijoh Koji, Nakamura Takumi, Yamashita Asami, Takayanagi Shunsaku, Sakamoto Masaki, Ishikawa Tatsuya
Department of Neurosurgery, Saitama Medical Center/Saitama Medical University, Japan.
Neurol Med Chir (Tokyo). 2007 May;47(5):233-6. doi: 10.2176/nmc.47.233.
A 53-year-old woman presented with a ruptured intramedullary aneurysmal dilatation fed by the anterior spinal artery associated with an arteriovenous malformation located in the ventral cervical spinal cord. She developed tetraparesis and respiratory dysfunction. The neurological deterioration was caused by hematomyelia due to the ruptured aneurysmal dilatation and progression of edema in the upper cervical spinal cord due to venous hypertension associated with additional hematoma in the medulla oblongata. Endovascular embolization of both C-1 and C-2 radicular arteries was performed with Guglielmi detachable coils, but components fed by small branches such as the radiculo-pial artery were not obliterated. Surgery was performed for extirpation of the arteriovenous malformation and cervical intramedullary hematoma, and excision of the aneurysmal dilatation through a transcondylar approach combined with vertebral artery transposition. Postoperatively, she overcame several complications such as pneumonia and endocarditis, and had only moderate weakness of the right upper and lower limbs. This case indicates that surgical intervention for high cervical intramedullary lesion may be very effective.
一名53岁女性，因脊髓前动脉供血的髓内动脉瘤样扩张破裂，同时合并位于颈髓腹侧的动静脉畸形而就诊。她出现了四肢轻瘫和呼吸功能障碍。神经功能恶化是由于动脉瘤样扩张破裂导致的脊髓出血，以及因延髓额外血肿导致静脉高压引起的颈上段脊髓水肿进展所致。使用 Guglielmi 可脱卸弹簧圈对C-1和C-2神经根动脉进行了血管内栓塞，但由诸如神经根软膜动脉等小分支供血的部分未被闭塞。通过经髁入路联合椎动脉转位进行手术，切除动静脉畸形和颈髓内血肿，并切除动脉瘤样扩张。术后，她克服了诸如肺炎和心内膜炎等多种并发症，仅右上肢和下肢有中度无力。该病例表明，对高位颈髓内病变进行手术干预可能非常有效。
