非造影の前交通動脈動脈瘤，2手術治験例

NON-FILLING RUPTURED ANEURYSM OF ANTERIOR COMMUNICATING ARTERY: REPORT OF TWO OPERATED CASES

緒言

　我々は先に前交通動脈動脈瘤とWillis動脈輪前半部の奇型および血流動態に関して検討を行ない，前交通動脈動脈瘤例においては約80％が一側の前大脳動脈A₁形成不全，または前交通動脈奇型を伴うか，機能的一側A₁血流不全を有すると報告した^3）。その報告の中で，頸動脈写にて動脈瘤が造影されなかつたクモ膜下出血の一症例に対して手術を行ない，前交通動脈瘤を確認した例があつたと簡単に述べたが，その後更に一例同様な症例を経験し治癒せしめたので，これらの2例の非造影の前交通動脈動脈瘤例の詳細と診断根拠について報告する。

Two cured cases of ruptured anterior communi-cating artery aneurysm whose repeated bilateral carotid angiographies showed no visualization of aneurysm were reported. They were treated by the direct operation after our confirmation of their existence.

Our diagnostic base for "Non-filling Aneurysm of Anterior Communicating Artery" is as follows.

A) Clinical findings

(1) Attack of the subarachnoidal haemorrhage

(2) Choked disc and/or retinal haemorrhage in the ocural fundus

(3) Hemiparesis which is stronger at lower ex- tremity

(4) Mental disturbance

B) Angiographic findings

(1) Non or less filling of unilateral A1 portion

(2) Visualization of bilateral As and A3 portion from opposite dominant Al portion

(3) Open and/or shift of the beginning parts of bilateral A₂ portion

(4) Angiospasm at the adjacent part of anterior communicating artery