Simultaneous Occurrence of Subarachnoid Hemorrhage and Epistaxis Due to Ruptured Petrous Internal Carotid Artery Aneurysm: Association With Transsphenoidal Surgery and Radiation Therapy-Case Report
Simultaneous Occurrence of Subarachnoid Hemorrhage and Epistaxis Due to Ruptured Petrous Internal Carotid Artery Aneurysm: Association With Transsphenoidal Surgery and Radiation Therapy-Case Report
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DOI：
10.2176/nmc.51.226
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发表时间：
2011-03-01
影响因子：
1.9
通讯作者：
Tominaga, Teiji
中科院分区：
文献类型：
--
作者：
Endo, Hidenori;Fujimura, Miki;Tominaga, Teiji
一位62岁女性患者同时出现蛛网膜下腔出血(SAH)和大量鼻出血。自43岁以来，患者接受了两次经蝶窦手术、伽玛刀放射外科手术和常规放射治疗。脑血管造影显示左侧岩部颈内动脉(ICA)动脉瘤，邻近左侧岩部颈内动脉(ICA)轻度狭窄。发病第二天，她接受了颞浅动脉-大脑中动脉(STA-MCA)双吻合术和血管内封堵术，无并发症。术后病程平稳，患者未出现症状性血管痉挛、复发性鼻出血或脑脊液鼻漏。术后血管造影显示动脉瘤完全消失，吻合口通畅。患者术后2个月出院，无神经功能障碍。本病例因岩性颈内动脉动脉瘤破裂而同时出现蛛网膜下腔出血及鼻出血，此病例极为罕见。经蝶窦手术和放射治疗可能在岩性颈内动脉动脉瘤的形成中起关键作用。
A 62-year-old woman presented with simultaneous subarachnoid hemorrhage (SAH) and massive epistaxis. The patient had been treated for pituitary prolactinoma by two transsphenoidal surgeries, gamma knife radiosurgery, and conventional radiation therapy since age 43 years. Cerebral angiography showed left petrous internal carotid artery (ICA) aneurysm with slight stenosis on the adjacent left petrous ICA. She underwent superficial temporal artery-middle cerebral artery (STA-MCA) double anastomosis with endovascular internal trapping without complication the day after onset. Postoperative course was uneventful; the patient did not develop symptomatic vasospasm, recurrent epistaxis, or cerebrospinal fluid rhinorrhea. Postoperative angiography demonstrated complete disappearance of the aneurysm with patent STA-MCA anastomosis. The patient was discharged 2 months after surgery without neurological deficit. The present case is extremely rare with simultaneous onset of SAH and epistaxis caused by ruptured petrous ICA aneurysm. The transsphenoidal surgeries and radiation therapies might have been critical in the formation of the petrous ICA aneurysm.