Angiographic features of "brain sag".
Angiographic features of "brain sag".
复制标题
“脑下垂”的血管造影特征。
DOI：
10.3171/2011.4.jns101168
复制
发表时间：
2011
影响因子：
4.1
通讯作者：
S. Amin‐Hanjani
中科院分区：
文献类型：
--
作者：
A. Alaraj;Troy A. Munson;S. R. Herrera;V. Aletich;F. Charbel;S. Amin‐Hanjani
对象
脑脊液低血压或“脑下垂”是最近描述的一种现象，最常见于开颅术夹闭破裂动脉瘤沿着术前腰椎引流放置后。其临床特征和CT表现已被描述。临床表现与脑血管痉挛相似，常被误认为脑血管痉挛。在这项研究中，作者报告了脑下垂患者的血管造影结果。
方法
在芝加哥的伊利诺伊大学，在手术治疗破裂的动脉瘤后诊断出5例脑下垂（范围1-4天）。所有患者均符合脑下垂的临床和CT标准。所有患者均获得入院脑血管造影片和随后的脑下垂症状期间的血管造影片。3例患者在症状缓解后进行了血管造影。
结果
在所有5例患者中，在脑下垂过程中，基底动脉尖相对于后床突水平向前移位。这种移位足以在3例患者的基底动脉中产生明显的扭结（“眼镜蛇征”）。其他血管造影结果包括颅内椎动脉缩短或扭结。所有患者的大脑后动脉均向内侧和外侧移位。3例患者同时接受重度放射性血管痉挛治疗。在4名患者中，发现了脑下垂，当患者平放或呈特伦德伦伯格卧位（有时结合硬膜外血贴）时，患者的病情得到改善。症状缓解后进行随访血管造影研究的患者显示血管造影特征逆转。
结论
脑下垂似乎与特征性血管造影特征相关。认识到这些特征可能有助于诊断脑下垂是该患者人群神经功能恶化的原因。
OBJECT
Cerebrospinal fluid hypotension, or "brain sag," is a recently described phenomenon most commonly seen following craniotomy for the clipping of ruptured aneurysms along with preoperative lumbar drain placement. The clinical features and CT findings have been previously described. Clinical presentation can be similar to and often mistaken for cerebral vasospasm. In this study, the authors report on the angiographic findings in patients with brain sag.
METHODS
Five cases of brain sag were diagnosed (range 1-4 days) after the surgical treatment of ruptured aneurysms at the University of Illinois at Chicago. All patients met the clinical and CT criteria for brain sag. Admission cerebral angiograms and subsequent angiograms during symptoms of brain sag were obtained in all patients. In 3 patients, angiography was performed after the resolution of symptoms.
RESULTS
In all 5 patients, the level of the basilar artery apex was displaced inferiorly with respect to the posterior clinoid processes during brain sag. This displacement was significant enough to create a noticeable kink in the basilar artery ("cobra sign") in 3 patients. Other angiographic findings included foreshortening or kinking of the intracranial vertebral artery. In all patients, the posterior cerebral arteries were displaced medially and inferiorly. Three patients were treated for simultaneous severe radiological vasospasm. In 4 patients, the brain sag was recognized, and the patients' conditions improved when they were placed flat or in the Trendelenburg position, at times combined with an epidural blood patch. Patients with follow-up angiography studies after the symptoms had resolved displayed a reversal of the angiographic features.
CONCLUSIONS
Brain sag appears to be associated with characteristic angiographic features. Recognizing these features may help to diagnose brain sag as the cause of neurological deterioration in this patient population.