外傷性傍床状突起部内頚動脈瘤に対して血行再建を施行した１例

抄録

Traumatic intracranial aneurysms are rare conditions that can result from non-penetrating head trauma. Because of the significant mortality and morbidity rates associated with this condition, early diagnosis and treatment are highly recommended. Here, we report one case of a traumatic aneurysm of the paraclinoid internal carotid artery (ICA). Briefly, a 23-year-old male was admitted to our hospital with disturbance of consciousness that developed after he fell from a high place. The patient's Glasgow Coma Scale was 8 (E1V2M5), and a computed tomography (CT) scan revealed an acute epidural hematoma, traumatic subarachnoid hemorrhage, and fractures at the anterior cranial base. A craniotomy to surgically remove the hematoma was immediately performed following the trauma; however, magnetic resonance angiography (MRA) on day 9 and CT angiography (CTA) on day 10 showed a wall irregularity of the right paraclinoid ICA. Cerebral angiography (CAG) on day 21 revealed that an aneurysm of the right paraclinoid ICA had developed; therefore, trapping with a high-flow bypass was performed on day 38. The bypass using left radial artery was performed between the right cervical external carotid artery and middle cerebral artery (M3), and trapping was performed between the right cervical and just proximal ICAs to a posterior communicating artery. Postoperative CAG showed no filling of the aneurysm and patency of the bypass, and on day 61, the patient was discharged from the hospital without any surgery-related complications. In conclusion, we recommend repeated CAG or CTA and MRA for the diagnosis of traumatic intra­cranial aneurysms. Additionally a high-flow bypass prior to aneurysm trapping may be useful in the surgical management of traumatic aneurysms of the paraclinoid ICA.