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Neurological Surgery No Shinkei Geka Volume 46, Issue 1 （January 2018）

Neurological Surgery 脳神経外科 46巻1号（2018年1月発行）

Japanese English

症例

両側頚部内頚動脈解離を来した茎状突起過長症の1例 Bilateral Internal Carotid Artery Dissection Caused by Elongated Styloid Processes:A Case Report 瀧野透 ¹ , 渋間啓 ¹ , 金丸優 ¹ , 岡村光司 ² , 大島章 ² , 田澤真奈美 ² , 梨本岳雄 ¹ , 土屋尚人 ¹ , 吉村淳一 ¹ , 根津公教 ² , 斎藤隆史 ¹ Toru TAKINO ¹ , Satoshi SHIBUMA ¹ , Yu KANEMARU ¹ , Koji OKAMURA ² , Aki OSHIMA ² , Manami TAZAWA ² , Takeo NASHIMOTO ¹ , Naoto TSUCHIYA ¹ , Junichi YOSHIMURA ¹ , Kiminori NETSU ² , Takafumi SAITO ¹ ¹長野赤十字病院脳神経外科 ²長野赤十字病院耳鼻咽喉科 ¹Department of Neurosurgery, Nagano Red Cross Hospital ²Department of Otolaryngology, Nagano Red Cross Hospital キーワード： carotid artery dissection , elongated styloid process , Eagle syndrome , surgical resection , endoscopy Keyword: carotid artery dissection , elongated styloid process , Eagle syndrome , surgical resection , endoscopy pp.53-59

発行日 2018年1月10日 Published Date 2018/1/10

DOI https://doi.org/10.11477/mf.1436203675

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Ⅰ．はじめに

　茎状突起過長症（Eagle症候群）は，咽頭喉頭周囲の違和感や疼痛などの症状を呈する疾患として，Eagleにより1937年に初めて報告された²⁾．これまで多くの報告がなされているが，過長した茎状突起が頚部内頚動脈を圧迫し，虚血性脳卒中を呈することはあまり知られていない．今回われわれは，両側頚部内頚動脈解離を契機に診断された茎状突起過長症の手術例を経験したので報告する．

　We report a case of bilateral internal carotid artery（ICA）dissection associated with bilateral elongated styloid processes（ESPs). A 46-year-old man presented with transient aphasia and left visual disturbance at a business meeting. He complained of a foreign body sensation in his throat during swallowing for two years. Magnetic resonance imaging（MRI）demonstrated fresh small infarcts in the left corona radiata. Magnetic resonance angiography（MRA）revealed string signs bilaterally in the cervical ICAs. The patient was diagnosed with bilateral idiopathic ICA dissection and was treated with ozagrel and clopidogrel. Three-dimensional computed tomographic angiogram（3DCTA）indicated bilateral ESPs and bilateral ICA stenosis. 3DCTA with the patient's head tilting and neck extension revealed that each ICA was compressed by the ipsilateral ESP. A follow-up MRA showed complete normalization of bilateral ICAs after neck rest and anti-platelet therapy, following which, clopidogrel was stopped. The patient wore a soft cervical collar until the operation, to avoid contact between the ESPs and ICAs due to changes in head position. Bilateral ESP resection was performed to prevent recurrence of cerebral ischemic events caused by ICA dissection. The patient was discharged one week after the surgery without any neurological deficit. There was no recurrence of symptoms during the next eight months after the operation.