Okawa Masakazu, Abe Hiroshi, Iwaasa Mitsutoshi, Nonaka Masani, Higashi Toshio, Inoue Tooru
Department of Neurosurgery, Faculty of Medicine, Fukuoka University.
No Shinkei Geka. 2014 Jan;42(1):47-52.
A 57-year-old man presented with sudden-onset consciousness disturbance. He had a 10-year history of a subarachnoid hemorrhage(SAH)caused by a ruptured aneurysm in the right middle cerebral artery, and had undergone aneurysmal clipping. He could perform all his daily life activities independently. Computed tomography showed diffuse SAH with intraventricular hemorrhage. Digital subtraction angiography(DSA)demonstrated mild fusiform dilatation of the left A2 portion of the left anterior cerebral artery(ACA)and the terminal portion of the left internal carotid artery with no sign of right middle cerebral artery(MCA)aneurysm recurrence. We could not identify the bleeding lesion at that time; therefore, conservative treatment was selected in the acute phase. Fourteen days later, repeated DSA showed fusiform dilatation of the left A2 portion leading to a diagnosis of ACA dissection. We initially performed superficial temporal artery(STA)-ACA anastomosis and secondary internal trapping with detachable coils in the operating room. Postoperative DSA revealed complete obliteration of the dissection and parent artery. Endovascular treatment with STA-ACA bypass is a safe and effective alternative for the treatment of ACA dissection.
一名57岁男性因突发意识障碍入院。他有10年因右侧大脑中动脉动脉瘤破裂导致蛛网膜下腔出血（SAH）的病史，曾接受动脉瘤夹闭术。他能够独立完成所有日常生活活动。计算机断层扫描显示弥漫性SAH伴脑室内出血。数字减影血管造影（DSA）显示左侧大脑前动脉（ACA）A2段及左侧颈内动脉末端轻度梭形扩张，右侧大脑中动脉（MCA）动脉瘤无复发迹象。当时我们无法确定出血病灶；因此，急性期选择保守治疗。14天后，重复DSA显示左侧A2段梭形扩张，诊断为ACA夹层。我们最初在手术室进行了颞浅动脉（STA）-ACA吻合术及二期使用可脱卸弹簧圈进行血管内栓塞。术后DSA显示夹层及供血动脉完全闭塞。STA-ACA搭桥血管内治疗是治疗ACA夹层的一种安全有效的替代方法。
