Primitive Hypoglossal Arteryを伴つた脳動脈瘤の2手術治験例

PERSISTENT PRIMITIVE HYPOGLOSSAL ARTERY WITH INTRACRANIAL ANEURYSM: TWO CASES OF SUCCESSFUL DIRECT ANEURYSM SURGERY

はじめに

　Primitive hypoglossal arteryと脳動脈瘤との併存する症例は極めてまれであり，現在まで外国において4例報告されているが，本邦においてはまだその報告はみられないようである。最近我々はかかる併発例を2例経験したので文献的考察を加えて報告する。

Two cases of the persistent primitive hypoglos-sal artery associated with aneurysm have been reported.

Case 1. A 48 year old woman was admitted to our clinic with subarachnoid hemorrhage. Left carotid angiography revealed an aneurysm of the anterior communicating artery and the persistent primitive hypoglossal artery. Under the hypo-thermic anesthesia, the aneurysmal neck was ligated. About 1 month after the operation, she left our clinic in good condition.

Case 2. A 34 year old woman was admitted with subarachnoid hemorrhage. The right carotid angio-gram showed the persistent primitive hypoglossal artery with an aneurysm at its entering portion into the cranium. Under the hypothermic anes-thesia, the aneurysmal neck was directly ligated carefully avoiding the cerebral blood flow inter-ruption of that arterial teritory. About 1 month after the operation, she was discharged in good condition.

We collected 59 reported cases of the persistent primitive hypoglossal artery including our two cases. Reviewing these cases, the symptoms and signs are related with other coexisting anomalous condition rather than persisting primitive hypo-glossal artery itself. It is commonly found at a chance of medical examination suspecting intra-cranial lesions, such as aneurysms or brain tumors and so on. On the literatures 6 cases of the intra-cranial aneurysm are reviewed in the 59 cases of this primitive artery with incidence of 10%.

Vertebral arteries are often hypoplastic or not visualized on angiograms. Thus it must be em-phasized that preservation of the primitive hypo-glossal arterial flow as a collateral circulation is necessary on the direct surgery for the accompany-ing aneurysm.