Kitanaka C, Sasaki T, Eguchi T, Teraoka A, Nakane M, Hoya K
Department of Neurosurgery, Tokyo University School of Medicine, Japan.
Neurosurgery. 1994 Apr;34(4):620-6; discussion 626-7. doi: 10.1227/00006123-199404000-00008.
We reviewed 24 patients with intracranial vertebral artery dissections treated during the last 12 years. Sixteen patients were admitted with subarachnoid hemorrhage (SAH) and 8 did not have SAH. The mean age at the time of onset was 50.0 years. Male preponderance was noted. Among 21 patients with acute onset, 6 (29%) experienced prodromal neck pain and 3 (60%) of 5 SAH patients showed nuchal stiffness when examined within 6 hours of onset. The preoperative angiographical findings were uniform in SAH cases in contrast to the varied angiographical findings seen in non-SAH cases. So-called pearl and string sign was observed in most SAH cases, but the "string" was often so short and wide that the term "constriction" appeared more suitable. From intraoperative observations, the angiographical point of constriction seemed to represent the proximal or distal end of dissection. As for treatment, 19 patients underwent 20 surgeries. Trapping was performed in eight surgeries, base clipping was performed in five, and proximal clipping was performed in seven. Both trapping and base clipping prevented further bleeding, but trapping was associated with a high rate of postoperative lower cranial nerve palsy. Postoperative neurological complications were less frequent after proximal clipping, but subsequent postoperative bleeding occurred in one patient treated by this technique. The overall long-term outcome in the surgically treated cases in our series was favorable, but most patients suffered from various degrees of uncomfortable dysphagia or hoarseness for some period after surgery. It was also noted that, in half of the disabled cases, the major disability was attributable to lower cranial nerve palsy and respiratory troubles that developed postoperatively.
我们回顾了过去12年中接受治疗的24例颅内椎动脉夹层患者。16例患者因蛛网膜下腔出血（SAH）入院，8例没有SAH。发病时的平均年龄为50.0岁。男性居多。在21例急性发病的患者中，6例（29%）有前驱颈部疼痛，5例SAH患者中有3例（60%）在发病6小时内检查时出现颈部僵硬。与非SAH病例中多样的血管造影表现不同，SAH病例的术前血管造影表现是一致的。大多数SAH病例观察到所谓的珍珠串征，但“串”通常很短很宽，以至于“狭窄”这个术语似乎更合适。从术中观察来看，血管造影的狭窄点似乎代表夹层的近端或远端。至于治疗，19例患者接受了20次手术。8次手术进行了血管夹闭术，5次进行了基底夹闭术，7次进行了近端夹闭术。血管夹闭术和基底夹闭术都防止了进一步出血，但血管夹闭术与术后较低的颅神经麻痹发生率相关。近端夹闭术后神经并发症较少，但采用该技术治疗的1例患者术后出现了后续出血。我们系列中手术治疗病例的总体长期预后良好，但大多数患者术后一段时间内都有不同程度的吞咽困难或声音嘶哑等不适。还注意到，在一半的残疾病例中，主要残疾归因于术后出现的颅神经麻痹和呼吸问题。
