2024. 11. 21 能中

大学院生　能中陽平先生の論文が　JNS Case lessons に掲載　

Nounaka Y, Matano F, Fujita H, Isayama K, Ideguchi M, Murai Y. J Neurosurg Case Lessons. 2024 Nov 18;8(21):CASE24332. doi: 10.3171/CASE24332. Print 2024 Nov 18.

Revascularization with superficial temporal artery-middle cerebral artery anastomosis in spontaneous intracranial internal carotid artery dissection: illustrative case

Abstract

Background: 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.

Observations: 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.

Lessons: 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.

Keywords: cerebral blood flow; digital subtraction angiography; internal carotid artery dissection; intracranial carotid artery dissection; single-photon emission computed tomography; superficial temporal artery–middle cerebral artery bypass.