Wada Hajime, Tokumitsu Naoki, Shirai Wakako, Sako Kazuhiro, Kamada Kyousuke
Department of Neurosurgery, Asahikawa Medical University, Hokkaido, Japan.
Neurol Med Chir (Tokyo). 2012;52(6):439-42. doi: 10.2176/nmc.52.439.
A 64-year-old woman with subarachnoid hemorrhage manifesting as sudden onset of severe headache visited our hospital on post-onset day 8. Diagnostic cerebral digital subtraction angiography revealed an aneurysm located at the left internal carotid-anterior choroidal artery with diffuse cerebral arterial spasm. Coil embolization was selected because of diffuse spasm in spite of parent artery elongation at the extra-cranial portion. A small portion of the coil migrated to the parent artery, but coil embolization was successfully completed. The patient developed delayed spasm, which required arterial fasudil hydrochloride injection. After the acute phase of subarachnoid hemorrhage, the patient's symptoms disappeared. However, on day 24 after subarachnoid hemorrhage, the patient showed right hemiparesis and total aphasia, and skull radiography revealed that the migrated coil had moved into the M1 portion of the left middle cerebral artery. Craniotomy was performed to retrieve the coil and clip the aneurysm neck. However, the migrated coil could not be retrieved because of adhesion to the arterial wall. Delayed coil migration is very rare in the chronic phase.
一名64岁女性，蛛网膜下腔出血表现为突发剧烈头痛，发病第8天来我院就诊。诊断性脑数字减影血管造影显示动脉瘤位于左颈内动脉 - 脉络膜前动脉，伴有弥漫性脑动脉痉挛。尽管颅外段母动脉延长，但由于弥漫性痉挛，仍选择了弹簧圈栓塞术。一小部分弹簧圈迁移至母动脉，但弹簧圈栓塞术仍成功完成。患者出现迟发性痉挛，需要注射盐酸法舒地尔。蛛网膜下腔出血急性期过后，患者症状消失。然而，蛛网膜下腔出血后第24天，患者出现右侧偏瘫和完全失语，颅骨X线摄影显示迁移的弹簧圈已移入左大脑中动脉M1段。遂行开颅手术取出弹簧圈并夹闭动脉瘤颈部。然而，由于与动脉壁粘连，迁移的弹簧圈无法取出。迟发性弹簧圈迁移在慢性期非常罕见。
