Hammock Middle Cerebral Artery and Delayed Infarction in Lenticulostriate Artery After Staged Resection of Giant Insular Glioma
Hammock Middle Cerebral Artery and Delayed Infarction in Lenticulostriate Artery After Staged Resection of Giant Insular Glioma
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DOI：
10.1016/j.wneu.2018.05.226
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发表时间：
2018-09-01
影响因子：
2
通讯作者：
Iwadate, Yasuo
中科院分区：
文献类型：
--
作者：
Hirono, Seiichiro;Ozaki, Ko;Iwadate, Yasuo
背景技术背景：岛叶胶质瘤切除后豆纹动脉（LSA）区域发生延迟性梗死并不常见，其病理生理学仍未知。病例描述：一名32岁右利手男子患有巨大的岛叶低级胶质瘤，并伴有额叶和颞叶延伸。采用有意分期手术策略进行清醒开颅术。术前影像学检查显示颞叶肿瘤斜向抬高大脑中动脉（MCA），纹状体明显受压。术中皮质下直接电刺激，切除完成在颞部的肿瘤，由于在颞干，疲劳和注意力丧失引起的语义性失语症。术后即刻的临床过程是顺利的。然而，在术后第20天，他突然出现右侧轻偏瘫。重复图像显示LSA区域梗死。先前受压的纹状体在20天内得到缓解并重新定位到原来的位置，MCA的M1段明显向下，其中MCA类似于吊床。血管造影证实了吊床形的MCA和显着拉伸LSA，这表明从压迫中解放的纹状体和肿瘤切除导致的颞叶结构丢失是MCA严重脱位和延迟缺血的关键机制。结论：在巨大岛叶胶质瘤的分期切除术中，应注意延迟术后可能发生的MCA严重脱位，这可能导致LSA伸展和延迟性梗死。
BACKGROUND: Delayed infarction in the lenticulostriate artery (LSA) area after insular glioma resection is not common, and its pathophysiology remains unknown.CASE DESCRIPTION: A 32-year-old right-handed man with a giant insular low-grade glioma with frontal and temporal extension underwent awake craniotomy with an intentional staged surgery strategy. Preoperative radiologic images demonstrated a diagonally elevated middle cerebral artery (MCA) by the temporal tumor and a significantly compressed striatum. With intraoperative subcortical direct electrical stimulation, the resection was finalized in the temporal part of the tumor due to the semantic paraphasia induced in the temporal stem, fatigue, and loss of concentration. The immediate postoperative clinical course was uneventful. However, on postoperative day 20, he suddenly experienced right hemiparesis. Repeated images revealed infarction in the LSA area. The previously compressed striatum was then relieved and relocated to its original position in just 20 days, and the M1 segment of the MCA was remarkably downward, in which the MCA resembled a hammock. Angiography confirmed the hammock-shaped MCA and significantly stretched LSA, suggesting the combination of freed striatum from the compression and loss of temporal structure by the tumor resection as the key mechanism of severe dislocation of the MCA and delayed ischemia.CONCLUSIONS: In a staged resection of giant insular glioma, attention should be paid to a possible severe dislocation of the MCA in a delayed postoperative period, which may lead to LSA stretching and delayed infarction.