片側モヤモヤ病に合併した破裂脳動脈瘤に対し脳血管内治療を行った1例

Endovascular Treatment of a Ruptured Aneurysm Associated with Unilateral Moyamoya Disease

　Ⅰ．はじめに

近年，脳血管内治療の技術の進歩により，全身麻酔下の開頭直達手術の困難な脳動脈瘤症例に対しても治療がより安全に行われるようになった．

　内頸動脈終末部近傍に進行性の狭窄や閉塞を来すモヤモヤ病は，脳循環の低下により一過性脳虚血発作や脳梗塞が，また脆弱なモヤモヤ血管の破綻により脳内出血が生じる原因不明の疾患である．本疾患に脳動脈瘤が合併することがあるが，その直達手術は一般に困難であり，また問題点も多い^{1,2,8,12,15,16)}．

　今回われわれは，片側モヤモヤ病に合併した破裂脳動脈瘤に対し，Gaglielmi Detachable Coil（GDC）を用いた脳動脈瘤瘤内塞栓術による治療を経験したので，文献的考察とともに報告する．

　We report a case presenting with subarachnoid hemorrhage due to a ruptured aneurysm associated with unilateral moyamoya disease. The patient was a 29-year-old woman exhibiting sudden onset headache. Computed tomography revealed subarachnoid hemorrhage around the brain stem. Cerebral angiography showed a saccular aneurysm at the junction of the left P1 portion of the posterior cerebral artery and its perforator. The right internal carotid artery was occluded at the terminal portion,and the right middle cerebral artery territory was perfused anterogradely via abnormal moyamoya vessels in the basal ganglia. The aneurysm was completely embolized with preservation of the perforator. We suggest that as compared to surgical clipping by craniotomy,endovascular therapy is safe and effective for treatment of intracranial aneurysms associated with moyamoya disease.