両側大型解離性椎骨動脈瘤の手術戦略:―この1例に学ぶ―

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It is very difficult to treat bilateral large vertebral dissecting aneurysms, because of the anatomical complexity and the technical difficulty of vascular reconstruction. We report a case of a 46-year-old male who presented with numbness of extremities and dysphagia caused by large bilateral vertebral dissections. The left vertebral dissection was trapped first, but subarachnoid hemorrhage caused by rupture of a right dissecting aneurysm occurred two days after surgery. The second operation was performed about one month after the first one by trapping of the right dissecting aneurysm combined with vertebral-posterior cerebral artery bypass using a radial artery graft. The patient returned to daily life about three months after the second operation. Surgical strategy for bilateral large vertebral dissections should be determined in consideration of the aneurysmal fragility, accessibility for vascular reconstruction and anatomical aspects.
一般社団法人日本脳卒中の外科学会の論文