Kamel M H, Murphy M, Kamel M H
Urology Department, Cork University Hospital, Cork, Ireland.
Acta Neurochir (Wien). 2008 Apr;150(4):367-70; discussion 370. doi: 10.1007/s00701-008-1518-9. Epub 2008 Feb 19.
Three patients were referred to a national neurosurgical centre following CT evidence of subarachnoid haemorrhage. The three patients, who were referred from different institutions within a seven week period, were Fisher grade 3 and WFNS Grade I at all times. Angiography showed a PCOM aneurysm in one case, a ruptured Basilar tip aneurysm and an unruptured ACOM aneurysm in another case, and an ACOM aneurysm in the third case. It was decided that the aneurysms were suitable for endovascular coiling. These patients had unremarkable intraoperative catheterizations and coiling but subsequently deteriorated post-operatively due to mesenteric ischaemia. Two patients required colectomy for mesenteric ischaemia, and the third arrested secondary to sepsis from bowel perforation. We discuss the various causes that may explain this association, and we alert the neurosurgical community for this complication which has not been reported before.
三名患者经CT检查证实存在蛛网膜下腔出血后，被转至一家国家级神经外科中心。这三名患者在七周内分别来自不同机构，Fisher分级始终为3级，WFNS分级始终为I级。血管造影显示，一例为后交通动脉瘤，另一例为破裂的基底动脉尖动脉瘤和未破裂的前交通动脉瘤，第三例为前交通动脉瘤。决定对这些动脉瘤进行血管内栓塞治疗。这些患者术中导管插入和栓塞过程顺利，但术后因肠系膜缺血而病情恶化。两名患者因肠系膜缺血需要进行结肠切除术，第三名患者因肠穿孔继发败血症而死亡。我们讨论了可能解释这种关联的各种原因，并提醒神经外科界注意这种此前未被报道过的并发症。
