Kuribara Tomoyoshi, Haraguchi Koichi, Ohtaki Shunya, Shimizu Tadakazu, Matsuura Nobuki, Ogane Kazumi, Maruo Yasunori, Yokoyama Noriyuki, Mikami Takeshi, Itou Takeo, Mikuni Nobuhiro
Department of Neurosurgery, Hakodate Shintoshi Hospital, Hakodate, Japan.
Department of Neurology, Hakodate Municipal Hospital, Hakodate, Japan.
Surg Neurol Int. 2018 Aug 28;9:173. doi: 10.4103/sni.sni_152_18. eCollection 2018.
The appearance of edematous lesions in the subacute phase is a rare complication following neuroendovascular therapy. Effective management of these lesions remains unclear. In this report, a case with progressive edematous lesions in the subacute phase after neuroendovascular therapy was described, and the clinical features and therapeutic strategies were discussed.
A 54-year-old female with a large, right cavernous internal carotid artery aneurysm was treated with a flow diverter. Left hemiparesis developed 15 days after the procedure, and multiple edematous lesions in areas of prior catheter procedures were revealed on radiological findings. Steroid pulse therapy was employed, and the lesions were gradually reduced without any additional neurological deficits. No recurrence was recognized in the follow-up study.
In some reports, pathological findings indicate that these lesions result from the presence of foreign bodies, and emboli could be caused by cotton fibers or hydrophilic polymers used as surface coatings on endovascular catheters. In this case, the edematous lesions were most likely caused by hydrophilic polymer emboli. Steroid pulse therapy had a beneficial effect on the lesions. It is important to effectively manage prescribed periods after the procedure to avoid such a rare complication.
亚急性期出现水肿性病变是神经血管内治疗后一种罕见的并发症。对这些病变的有效管理仍不明确。在本报告中，描述了1例神经血管内治疗后亚急性期出现进行性水肿性病变的病例，并讨论了其临床特征和治疗策略。
1例54岁女性，患有右侧海绵窦段颈内动脉大型动脉瘤，接受了血流导向装置治疗。术后15天出现左侧偏瘫，影像学检查发现先前导管操作区域有多个水肿性病变。采用了类固醇冲击疗法，病变逐渐减轻，未出现任何额外的神经功能缺损。随访研究未发现复发。
在一些报告中，病理结果表明这些病变是由异物存在引起的，栓子可能由用作血管内导管表面涂层的棉纤维或亲水性聚合物引起。在本病例中，水肿性病变很可能是由亲水性聚合物栓子引起的。类固醇冲击疗法对病变有有益作用。术后有效管理规定时期以避免这种罕见并发症很重要。
