Stanford A型急性大動脈解離に起因した重症の脳梗塞に対して開頭外減圧療法が有効であった1例

Effectiveness of Decompressive Craniectomy for Severe Cerebral Infarction Caused by Stanford Type A Acute Aortic Dissection：Report of a Case

はじめに　脳梗塞を伴ったStanford A型急性大動脈解離例に対する大動脈修復術は梗塞後脳出血や広範な脳浮腫のリスクを伴い予後不良であるが，内科的治療の成績も著しく不良である．われわれはStanford A型急性大動脈解離に脳梗塞を伴った症例に対して緊急で大動脈修復術を施行し，術後に脳幹圧迫症状が出現したが，開頭外減圧療法を施行することで救命できた症例を経験したので報告する．

The optimal surgical management of Stanford type A acute aortic dissection complicated by severe cerebral infarction remains controversial. We present a case of a 48-year-old man with Stanford type A acute aortic dissection complicated by malperfusion of the right common carotid artery. His consciousness was deteriorating preoperatively, and we performed an emergent aortic root replacement and partial aortic arch replacement. He suffered a severe cerebral edema with a brain herniation caused by cerebral infarction after the surgery. Decompressive craniectomy saved his life and improved his neurologic functions, and he has become able to communicate well. It is suggested that the decompressive craniectomy for the severe cerebral infarction after a surgery for type A acute aortic dissection with cerebral malperfusion is a good option for better neurologic outcomes.