Horio Yoshinobu, Katsuta Toshiro, Samura Kazuhiro, Wakuta Naoki, Fukuda Kenji, Higashi Toshio, Inoue Tooru
Department of Neurosurgery, Faculty of Medicine, Fukuoka University.
Neurol Med Chir (Tokyo). 2015;55(12):915-9. doi: 10.2176/nmc.cr.2015-0210. Epub 2015 Oct 30.
There are very few published reports of rupture of an isolated posterior spinal artery (PSA) aneurysm, and consequently the optimal therapeutic strategy is debatable. An 84-year-old man presented with sudden onset of restlessness and disorientation. Neuroradiological imaging showed an intracranial subarachnoid hemorrhage (SAH) with no visible intracranial vascular lesion. Spinal magnetic resonance imaging (MRI) detected a localized subarachnoid hematoma at Th10-11. Both contrast-enhanced spinal computed tomography and enhanced MRI and magnetic resonance angiography revealed an area of enhancement within the hematoma. Superselective angiography of the left Th12 intercostal artery demonstrated a faintly enhanced spot in the venous phase. Thirteen days after the onset of symptoms, a small fusiform aneurysm situated on the radiculopial artery was resected. The patient's postoperative course was uneventful and he was eventually discharged in an ambulatory condition. To our knowledge, this 84-year-old man is the oldest reported case of surgical management of a ruptured isolated PSA aneurysm. This case illustrates both the validity and efficacy of this therapeutic approach.
关于孤立性脊髓后动脉（PSA）动脉瘤破裂的已发表报告极少，因此最佳治疗策略存在争议。一名84岁男性因突然出现烦躁不安和定向障碍就诊。神经放射学成像显示颅内蛛网膜下腔出血（SAH），未见颅内血管病变。脊髓磁共振成像（MRI）检测到胸10 - 11水平局限性蛛网膜下腔血肿。增强脊髓计算机断层扫描、增强MRI及磁共振血管造影均显示血肿内有强化区域。左胸12肋间动脉超选择性血管造影显示静脉期有一微弱强化点。症状出现13天后，切除了位于神经根软膜动脉上的一个小梭形动脉瘤。患者术后恢复顺利，最终步行出院。据我们所知，这位84岁男性是报道的接受破裂孤立性PSA动脉瘤手术治疗的年龄最大的病例。该病例说明了这种治疗方法的有效性和疗效。
