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男,44岁。因枕项部包块13年入院。肿瘤初位于枕部正中,生长缓慢。近年增长较快,伴疼痛、右耳鸣、颈部活动受限。无头痛、晕厥。3年前拟行手术,因静脉全麻后肿瘤突然增大未手术,后行3次脑血管造影均不成功,末次造影后遗左侧轻偏瘫,以颈后巨大动脉瘤转入我院。体检:血压16/8kPa。颅神经正常。枕项部肿块约17cm×15cm×11cm,有囊感,边界右侧尚清,皮肤表面血管怒张,有血管搏动,压迫后肿瘤可缩小,血管杂音明显。左侧肢体肌力Ⅳ级,肌张力高,腱反射亢进。肿块穿刺为鲜红色血液。入院后经股动脉插管行全脑血管造影,示:第兰颈椎平面有约2mm粗的血管自颈内动脉分出,向上向后行走,与椎动脉相连,其末梢与枕项部血管相通。颈
Male, 44 years old. Pillow department for 13 years due to admission. Early tumor located in the middle of the occipital, slow growth. In recent years, rapid growth, with pain, right tinnitus, neck activity is limited. No headache, syncope. 3 years ago, the proposed surgery, due to a sudden increase in tumor size after general anesthesia without surgery, after three consecutive cerebrovascular angiography were unsuccessful, the left hemiplegia left after the last angiography to the huge cervical aneurysm into our hospital. Physical examination: blood pressure 16 / 8kPa. Cranial nerve normal. Pillow lumps of about 17cm × 15cm × 11cm, a sense of capsule, the border is clear on the right, the skin surface vascular engorgement, vascular beats, the tumor can be reduced after compression, vascular murmur significantly. Left limb muscle strength Ⅳ, high muscle tension, tendon hyperreflexia. Massive puncture for the bright red blood. After admission through the femoral artery intubation whole cerebrovascular angiography, showed: first cervical cervical plane about 2mm thick vascular separation from the internal carotid artery, walking up and back, connected with the vertebral artery, the peripheral vessels and occiput vascular communication . neck