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Neurological Surgery No Shinkei Geka Volume 34, Issue 11 （November 2006）

Neurological Surgery 脳神経外科 34巻11号（2006年11月発行）

Japanese English

症例

主幹動脈閉塞症に合併した多発性脳動脈瘤の2例 Two Cases of Main Trunk Artery Occlusion Associated with Multiple Cerebral Aneurysms 井上明宏 ¹ , 河野兼久 ¹ , 武田哲二 ¹ , 武智昭彦 ¹ , 河野啓二 ¹ , 山口佳昭 ¹ , 石井大造 ¹ , 佐々木潮 ¹ Akihiro INOUE ¹ , Kanehisa KOHNO ¹ , Tetsuji TAKEDA ¹ , Akihiko TAKECHI ¹ , Keiji KOHNO ¹ , Yoshiaki YAMAGUCHI ¹ , Daizo ISHII ¹ , Ushio SASAKI ¹ ¹愛媛県立中央病院脳神経外科 ¹Department of Neurosurgery,Ehime Prefectural Central Hospital キーワード： main trunk artery occlusion , STA-MCA anastomosis , non-ruptured aneurysm , ruptured aneurysm Keyword: main trunk artery occlusion , STA-MCA anastomosis , non-ruptured aneurysm , ruptured aneurysm pp.1131-1138

発行日 2006年11月1日 Published Date 2006/11/1

DOI https://doi.org/10.11477/mf.1436100305

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参考文献 Reference

Ⅰ．はじめに

　もやもや病の側副血管には，血流負荷によると考えられる動脈瘤が生ずることは広く知られており¹¹⁾，同病態に合併した末梢性動脈瘤は親血管への血流負荷の変化でしばしば自然消失する⁷⁾．しかし，もやもや病の病態とは無関係の特発性，アテローム硬化性中大脳動脈閉塞などの慢性閉塞性脳血管病変に，血流負荷による脳動脈瘤が合併する症例も散見されており¹¹⁾，このような症例に関する治療方針についてはいまだ明確なものは存在しない．今回われわれは，脳主幹動脈閉塞に合併した多発性脳動脈瘤の2症例を経験した．1つは虚血発作にて発症した非破裂性多発脳動脈瘤の症例であり，もう1つはくも膜下出血にて発症した脳主幹動脈閉塞の症例である．前者は，血行再建術を施行した後にクリッピング術を二期的に施行，また後者は一期的に血行再建術，クリッピング術を行った症例であり，両者ともに術後良好な経過を得ている．これらの2症例に関して，脳動脈瘤の発生機序ならびに主要血管の閉塞と脳動脈瘤との合併例に対する治療方針について，文献的考察を含め検討を加えたので報告する．

　We report 2 cases of multiple aneurysms (AN) associated with main trunk artery occlusion.

　Case 1　A 52-year-old male was admitted to our hospital with dysarthria and weakness of the right side of the body. Computed tomography (CT) showed cerebral infarction in the left corona radiata. MR angiography and conventional angiography showed occlusion of the left middle cerebral artery (MCA) and saccular aneurysms (ANs) at the origin of the anterior communicating artery (A-com) and bifurcation of the right MCA. Subsequent ¹²³ I-IMP-single photon emission tomography (SPECT) revealed marked reduction of cerebral blood flow and disturbed reactivity to acetazolamide in the left cerebral hemisphere. Superficial temporal artery (STA)-MCA anastomosis was performed to improve cerebral blood flow and reduce hemodynamic stress for AN of the A-com and right MCA. At 5 months after the fi rst operation,neck clipping was performed successfully for the non-ruptured A-com AN and right MCA AN.

　Case 2　A 65-year-old male was admitted to our hospital. CT revealed subarachnoid hemorrhage (SAH),and 3D-computed tomographic angiography (CTA) and cerebral angiography showed basilar top AN,A-com AN and right MCA AN associated with right internal carotid artery occlusion. Right ACA and MCA territories were visualized from the A-com artery and posterior cerebral artery. STA-MCA anastomosis was performed to improve cerebral blood flow and reduce hemodynamic stress for ANs. In the same operation,successful neck clipping was performed for BA top AN and right MCA AN.

　In such cases as these,particularly in ischemic cases associated with main trunk artery occlusion,it was important to consider surgery for AN after STA-MCA anastomosis in anticipation of improved cerebral blood flow and reduce hemodynamic stress for AN.