Oláh Zsolt Csaba, Nagy Dávid, Sas Attila, Oláh Benedek, Czabajszki Máté, Tamáska Péter, Demeter Béla
BAZ Megyei Központi Kórház és Egyetemi Oktató Kórház, Intervenciós Radiológia Osztály, Miskolc.
BAZ Megyei Központi Kórház és Egyetemi Oktató Kórház, Idegsebészeti Osztály, Miskolc.
Ideggyogy Sz. 2024 Jul 30;77(7-8):283-287. doi: 10.18071/isz.77.0283.
If severe cervical spinal cord injury or severe cervical vertebral fracture, subluxation or luxation is confirmed, 20-40% of the cases have vertebral artery dissection or occlusion. These can be asymptomatic, but can cause additional neurological damage in addition to cervical myelon and cervical nerve root symptoms. Vertebral artery dissection can be caused by direct injuries, stab wounds or gunshot wounds. Indirect vertebral artery dissection can occur at the same time as subluxation, luxation, or complex fractures of the cervical vertebra. CTA is the examination procedure of choice. In many cases, digital subtaction angiography examination and, if necessary, neurointerventional treatment must precede open neurosurgery. In our report, in the first patient, complete luxation of the C.VI vertebra caused unilateral vertebral artery 2-segment dissection-occlusion, while in our second patient, a stab injury caused direct vertebral artery compression and dissection. The occlusion of the vertebral artery did not cause neurological symptoms in any of the cases. In both of our cases, parent vessel occlusion was performed at the level of the vertebral artery injury before the neurosurgical operation.
如果确诊为严重的颈脊髓损伤或严重的颈椎骨折、半脱位或脱位，20%至40%的病例会发生椎动脉夹层或闭塞。这些情况可能无症状，但除了颈髓和颈神经根症状外，还可能导致额外的神经损伤。椎动脉夹层可由直接损伤、刺伤或枪伤引起。间接椎动脉夹层可与颈椎半脱位、脱位或复杂骨折同时发生。CTA是首选的检查方法。在许多情况下，必须先进行数字减影血管造影检查，必要时进行神经介入治疗，然后再进行开放性神经外科手术。在我们的报告中，第一例患者，第六颈椎完全脱位导致单侧椎动脉2段夹层闭塞，而第二例患者，刺伤导致椎动脉直接受压和夹层。在任何病例中，椎动脉闭塞均未引起神经症状。在我们的两个病例中，均在神经外科手术前于椎动脉损伤水平进行了母血管闭塞。
