Tajiri Takato, Fukuda Kenji, Katsuta Toshiro, Abe Hiroshi, Inoue Tooru
Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan.
Department of Neurosurgery, Saiseikai Karatsu Hospital, Karatsu, Saga, Japan.
NMC Case Rep J. 2021 Apr 2;8(1):89-93. doi: 10.2176/nmccrj.cr.2020-0100. eCollection 2021 Apr.
We describe a rare case of an anterolaterally projecting clinoid segment aneurysm of the internal carotid artery (ICA) causing oculomotor palsy. A 76-year-old woman was referred to our facility because of right oculomotor palsy that had been found just before surgery to remove bilateral cataracts. Neuroimaging revealed that the patient had an aneurysm at the clinoid segment that projected anterolaterally, eroding the anterior clinoid process. The aneurysm was thought to be compressing the oculomotor nerve, which runs at the upper part of the lateral wall of the cavernous sinus, thereby causing oculomotor palsy. Endovascular coiling of the aneurysm was successfully performed, and the oculomotor palsy was alleviated postoperatively. Anatomically, there exists the carotid collar between the arterial wall of the clinoid segment and the anterior clinoid process, containing the clinoid venous plexus in it. Hence, the anterolateral wall of the clinoid segment, although protected by a stiff bony structure, has an anatomical base that allows it to protrude centrifugally. Once protrusion occurs, the bone may be eroded by remodeling caused by the aneurysm's pulsed beating.
我们描述了一例罕见的引起动眼神经麻痹的颈内动脉床突段动脉瘤，该动脉瘤向前外侧突出。一名76岁女性因在双侧白内障手术前发现右侧动眼神经麻痹而被转诊至我院。神经影像学检查显示，患者在床突段有一个向前外侧突出的动脉瘤，侵蚀了前床突。该动脉瘤被认为压迫了走行于海绵窦外侧壁上部的动眼神经，从而导致动眼神经麻痹。成功实施了动脉瘤的血管内栓塞术，术后动眼神经麻痹得到缓解。从解剖学角度来看，在床突段动脉壁与前床突之间存在颈动脉环，其中包含床突静脉丛。因此，床突段的前外侧壁虽然受到坚硬骨质结构的保护，但具有允许其离心性突出的解剖学基础。一旦发生突出，骨质可能会因动脉瘤搏动引起的重塑而被侵蚀。
