Nounaka Yohei, Matano Fumihiro, Fujita Hiroaki, Isayama Koshiro, Ideguchi Minoru, Murai Yasuo
Department of Neurological Surgery, Nippon Medical School Hospital, Bunkyo City, Tokyo, Japan.
Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan.
J Neurosurg Case Lessons. 2024 Nov 18;8(21). doi: 10.3171/CASE24332.
Because of ischemic symptoms, intracranial internal carotid artery (IICA) dissection has no established treatment guidelines. The authors report a case of IICA dissection in which an emergency superficial temporal artery-middle cerebral artery (STA-MCA) bypass was performed.
A 46-year-old woman presented with a headache and left hemiplegia. Her cortical symptoms appeared on day 10, and an STA-MCA bypass was performed because of cerebral hypoperfusion. Her postoperative patency was good, and cortical symptoms improved. Contrast-enhanced magnetic resonance imaging (MRI) was performed in the acute phase with wall contrast. From day 18, the internal carotid artery delineation improved, and the patient was transferred for rehabilitation without worsening symptoms. A literature review of spontaneous IICA dissection with revascularization procedures was conducted to discuss the indications, timing, treatment modalities, and surgical outcomes.
The STA-MCA bypass provides supplemental cerebral blood flow and can prevent critical complications. Contrast-enhanced MRI in the acute phase of dissection can show a wall contrast effect and assist in predicting disease progression. https://thejns.org/doi/10.3171/CASE24332.
由于存在缺血症状，颅内颈内动脉（IICA）夹层尚无既定的治疗指南。作者报告了一例IICA夹层病例，该病例接受了急诊颞浅动脉-大脑中动脉（STA-MCA）搭桥手术。
一名46岁女性出现头痛和左侧偏瘫。其皮质症状在第10天出现，因脑灌注不足进行了STA-MCA搭桥手术。术后血管通畅良好，皮质症状改善。在急性期进行了壁造影剂增强磁共振成像（MRI）检查。从第18天起，颈内动脉显影改善，患者在症状未加重的情况下转至康复科。对采用血管重建术治疗的自发性IICA夹层进行了文献综述，以讨论适应证、时机、治疗方式和手术结果。
STA-MCA搭桥可提供额外的脑血流量，并可预防严重并发症。夹层急性期的增强MRI可显示壁造影剂增强效应，并有助于预测疾病进展。https://thejns.org/doi/10.3171/CASE24332
