Nagatani Kimihiro, Tsuzuki Nobusuke, Kageyama Hiroshi, Shima Katsuji
National Defense Medical College, Department of Neurosurgery,Tokorozawa, Saitama, Japan.
Turk Neurosurg. 2015;25(1):154-7. doi: 10.5137/1019-5149.JTN.8877-13.0.
Proximal ligation of the internal carotid artery (ICA) with high-flow bypass is one of the surgical strategies for treating large, unclippable ICA aneurysms. We encountered a rare case of recanalization of a large ICA aneurysm that disappeared after high-flow bypass surgery, and subsequently reappeared via an elicited vertebral artery (VA)-ICA anastomosis (anastomosis between the anterior meningeal artery branching from the right VA, and the ascending pharyngeal artery branching (APA) from the right ICA). To the best of our knowledge, this is the first case report describing angiographical recurrence of a large ICA aneurysm after the surgery. Periodic long-term follow-up by neuroimaging may be necessary after this surgery, particularly in cases of ICA proximal ligation with the ICA aneurysm, when the APA has not been clearly identified as a branch from the ipsilateral external carotid artery on the preoperative angiogram.
采用高流量搭桥术对颈内动脉（ICA）进行近端结扎是治疗大型、无法夹闭的ICA动脉瘤的手术策略之一。我们遇到了1例罕见的大型ICA动脉瘤再通病例，该动脉瘤在高流量搭桥手术后消失，随后通过诱发的椎动脉（VA）-ICA吻合（从右侧VA分支的前脑膜动脉与从右侧ICA分支的咽升动脉（APA）之间的吻合）再次出现。据我们所知，这是第一例描述手术后大型ICA动脉瘤血管造影复发的病例报告。该手术后可能需要通过神经影像学进行长期定期随访，尤其是在对ICA动脉瘤进行ICA近端结扎的病例中，当术前血管造影未明确将APA确定为同侧颈外动脉的分支时。
