自发性颈内动脉夹层伴展神经麻痹的外科治疗：病例报告及文献综述
Surgical Treatment of Spontaneous Internal Carotid Artery Dissection with Abducent Nerve Palsy: Case Report and Review of Literature.
作者信息
Tsuboki Shimpei, Kawano Takayuki, Ohmori Yuki, Amadatsu Toshihiro, Mukasa Akitake
机构信息
Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
出版信息
World Neurosurg. 2019 May;125:10-14. doi: 10.1016/j.wneu.2019.01.096. Epub 2019 Jan 31.
BACKGROUND
Sixth-nerve palsy often develops as a result of trauma, neoplasm, or vascular disease affecting the pons. Less commonly, this palsy can be caused by pathology of the internal carotid artery in the cavernous sinus region. Here, we describe a rare case of spontaneous dissection of the internal carotid artery in the cavernous sinus accompanied by acute sixth nerve palsy that was successfully treated with surgery.
CASE DESCRIPTION
An 18-year-old man presented suddenly and spontaneously with isolated abducent nerve palsy. His magnetic resonance angiography identified a dissection of the right internal carotid artery in the cavernous sinus. We successfully treated it with high-flow bypass and ligation of the internal carotid artery (ICA).
CONCLUSIONS
Intracavernous ICA dissection is a possible cause of sixth nerve palsy. While most cases likely result from compromised arterial blood supply to the affected nerve, compression of the cranial nerves by the expanded artery can occur in some cases. Surgical treatment is a safe and effective option for relieving nerve compression after intracavernous ICA dissection.
背景
第六脑神经麻痹常因影响脑桥的创伤、肿瘤或血管疾病而发生。较少见的情况下，这种麻痹可由海绵窦区域颈内动脉的病变引起。在此，我们描述一例罕见的海绵窦内颈内动脉自发性夹层伴急性第六脑神经麻痹的病例，该病例通过手术成功治疗。
病例描述
一名18岁男性突然自发出现孤立性展神经麻痹。他的磁共振血管造影显示海绵窦内右侧颈内动脉夹层。我们通过高流量搭桥和颈内动脉结扎成功治疗了该病例。
结论
海绵窦内颈内动脉夹层是第六脑神经麻痹的一个可能原因。虽然大多数病例可能是由于受影响神经的动脉血供受损，但在某些情况下，扩张的动脉可压迫脑神经。手术治疗是海绵窦内颈内动脉夹层后缓解神经压迫的一种安全有效的选择。
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