从颈内动脉海绵假动脉瘤破裂蝶手术后11年
背景:Bioabsorbable板块经常利用在蝶后的修复颅底缺损操作。创伤性颅内假性动脉瘤是一种罕见的反式-楔形的手术并发症。迄今为止,医源性颈动脉pseu - doaneurysm与吸收的使用能板报道一次。结果一个57岁的人大量非功能性垂体macroadenoma接受了内镜经鼻-蝶窦与总计切除手术。可吸收板放置硬膜外的重新构建sellar地板上。他经历了延迟反复鼻出血,紧随其后的是一个正确的蜡膜中间——bral动脉栓塞中风的分布。计算——morgraphy术后6周(CT)血管造影显示6×4毫米的假动脉瘤位于内侧墙右颈内动脉海绵。支架卷已成功用于obliter——吃了假动脉瘤病人完全recov——赔率。结论延迟的侵蚀造成的颈动脉壁板用来重建sellar楼可能显化与鼻出血或栓塞中风。作者的偏好是避免插入的刚性板sellar楼重建没有术中脑脊液(CSF)泄漏,联合国——那么它需要支持大量颅底缺损。 Short-segment embolization with stent coiling is the preferred treatment option for carotid pseudoaneu- rysms following transsphenoidal operations. Keywords: cavernous, carotid, pseudoaneurysm, ar- tery Introduction: The transsphenoidal approach is the most commonly utilized operation for the surgical treatment of sellar lesions and is a relatively safe op- eration in experienced centers.1 Following resection of pituitary adenomas and other sellar tumors, many surgeons utilize absorbable plates to reconstruct the bony sellar floor to serve as a buttress for the sellar contents and repair construct. Although usually safe, vascular injury in conjunction with insertion of rigid plates following sellar tumor resection has been de- scribed once before.2 Common complications of transsphenoidal opera- tions include endocrine abnormalities and cerebro- spinal fluid (CSF) leaks.3 Vascular injury is a rare but serious complication of transsphenoidal surgery en- countered in 0.8 to 1.1% of cases, with an associated mortality of nearly 30%.4,5,6 The majority of vascu- lar injuries are identified at the time of surgery, usu- ally resulting from direct injury to the internal carotid artery during resection of tumor within the cavern- ous sinus or upon opening of the dura, often result- ing in profuse arterial hemorrhage.6,7,8,9 Other de- scribed vascular complications include vasospasm, carotid thrombosis, cavernous sinus thrombosis, embolism, caroticocavernous fistula, or pseudoan- eurysm.2,3,7,8,10,11,12,13,14,15,16,17,18,19 Postoperative carotid pseudoaneurysm, though rare, represents a grave risk to the patient if unrecognized. It may lead to delayed hemorrhagic or embolic com- plications when the patient is no longer in a moni- tored hospital setting. This case report highlights the importance of rapid diagnosis and treatment of these lesions. We present a rare case of delayed pseudo- aneurysm and embolic stroke following erosion of a rigid plate into the cavernous internal carotid artery. Case Report: A 57-year-old man with a nonfunction- al pituitary macroadenoma causing vision loss un- derwent a gross total, endoscopic transsphenoidal resection (Fig. 1). The tumor was invading the right cavernous sinus wall. During the procedure to resect
汤姆·莫里森
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