Goehre Felix, Kamiyama Hiroyasu, Kosaka Akira, Tsuboi Toshiyuki, Miyata Shiro, Noda Kosumo, Jahromi Behnam Rezai, Ohta Nakao, Tokuda Sadahisa, Hernesniemi Juha, Tanikawa Rokuya
*Department of Neurosurgery, Stroke Center, Bergmannstrost Hospital Halle, Halle, Germany; ‡Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan; §Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
Neurosurgery. 2014 Jun;10 Suppl 2:174-8; discussioin 178. doi: 10.1227/NEU.0000000000000284.
In a short window of time, intravenous and intra-arterial thrombolysis is the first treatment option for patients with an acute ischemic stroke caused by the occlusion of one of the major brain vessels. Endovascular treatment techniques provide additional treatment options. In selected cases, high revascularization rates following microsurgical thromboembolectomy in the anterior circulation were reported. A technical note on successful thromboembolectomy of the proximal posterior cerebral artery has not yet been published.
To describe the technique of microsurgical thromboembolectomy of an acute proximal posterior cerebral artery occlusion and the brainstem perforators via the anterior temporal approach.
The authors present a technical report of a successful thromboembolectomy in the proximal posterior cerebral artery. The 64-year-old male patient had an acute partial P1 thromboembolic occlusion, with contraindications for intravenous recombinant tissue plasminogen activator. The patient underwent an urgent microsurgical thromboembolectomy after a frontotemporal craniotomy.
The postoperative computerized tomography angiography showed complete recanalization of the P1 segment and its perforators, which were previously occluded. The early outcome after 1 month and 1 year follow-ups showed improvement from modified Rankin scale 4 to modified Rankin scale 1.
Microsurgical thromboembolectomy can be an effective treatment option for proximal occlusion of the posterior cerebral artery in selected cases and experienced hands. Compared with endovascular treatment, direct visual control of brainstem perforators is possible.
在短时间内，静脉和动脉内溶栓是由主要脑血管之一闭塞引起的急性缺血性卒中患者的首选治疗方案。血管内治疗技术提供了额外的治疗选择。在某些病例中，有报道称在前循环中进行显微外科血栓切除术的再通率很高。关于大脑后动脉近端成功进行血栓切除术的技术说明尚未发表。
描述经颞前入路对大脑后动脉近端闭塞及脑干穿支进行显微外科血栓切除术的技术。
作者介绍了一例大脑后动脉近端成功进行血栓切除术的技术报告。该64岁男性患者患有急性P1段血栓栓塞性闭塞，存在静脉注射重组组织型纤溶酶原激活剂的禁忌证。患者在接受额颞开颅术后接受了紧急显微外科血栓切除术。
术后计算机断层血管造影显示先前闭塞的P1段及其穿支完全再通。1个月和1年随访后的早期结果显示，改良Rankin量表评分从4分改善到1分。
对于某些病例且由经验丰富的术者操作时，显微外科血栓切除术可能是大脑后动脉近端闭塞的一种有效治疗选择。与血管内治疗相比，可直接目视控制脑干穿支。
