Ueyama T, Tamaki N, Ishihara Y, Hosoi K, Kondoh T, Nakamura M, Asada M
Department of Neurosurgery, Kobe University School of Medicine.
No Shinkei Geka. 1997 Mar;25(3):253-8.
We present a case with the traumatic extracranial internal carotid artery dissecting aneurysm. A 21-year-old man was involved in a motorcycle accident, resulting in multiple injuries but no apparent head and neck injuries. Head CT was normal on his admission. He was discharged from his local hospital 3 weeks after the accident without any neurological deficits. Five weeks after the accident, he suddenly presented with a motor aphasia and a right hemiparesis. CT and MRI showed infarctions in the left para-Sylvian and the left angular areas. Angiography showed a left extracranial carotid artery dissecting aneurysm at the level of C1 vertebral arch. The patient was initially managed by an anticoagulant agent, but he suffered from another transient ischemic attack due to distal embolism from the aneurysm. Balloon occlusion test of the left ICA was performed under monitoring EEG, SEP. Mean stump pressure (MSP) revealed 60 mmHg. and MSP/Mean systematic blood pressure revealed 67%. We judged that the left ICA ligation was a safe method to treat this patient, however, considering the patient's age and the side of the lesion, left STA-MICA bypass and ligation of the left ICA were carried out in one stage. Postoperatively, the patient did not show any cerebral ischemic complications and angiography showed disappearance of the aneurysm and patency of the bypass. The left MCA territories were filled well by cross circulation and the bypass.
我们报告一例创伤性颅外颈内动脉夹层动脉瘤病例。一名21岁男性遭遇摩托车事故，导致多处受伤，但无明显的头部和颈部损伤。入院时头部CT正常。事故发生3周后，他从当地医院出院，无任何神经功能缺损。事故发生5周后，他突然出现运动性失语和右侧偏瘫。CT和MRI显示左侧外侧裂旁和左侧角回区域梗死。血管造影显示在C1椎弓水平有左侧颅外颈动脉夹层动脉瘤。患者最初接受抗凝剂治疗，但因动脉瘤远端栓塞又发生了一次短暂性脑缺血发作。在脑电图、体感诱发电位监测下对左侧颈内动脉进行球囊闭塞试验。平均残端压力（MSP）为60 mmHg，MSP/平均体循环血压为67%。我们判断左侧颈内动脉结扎是治疗该患者的安全方法，然而，考虑到患者年龄和病变部位，一期进行了左侧颞浅动脉-大脑中动脉搭桥术并结扎左侧颈内动脉。术后，患者未出现任何脑缺血并发症，血管造影显示动脉瘤消失且搭桥血管通畅。左侧大脑中动脉供血区域通过交叉循环和搭桥血管得到良好灌注。
