遺残性原始三叉動脈に対側頸部内頸動脈閉塞を伴った多発性脳動脈瘤の手術例

Multiple Cerebral Aneurysms and a Contralateral Occluded Internal Carotid Artery Associated with Persistent Primitive Trigeminal Artery

　Ⅰ．はじめに

Persistent primitive trigeminal artery（PTA）は胎生期遺残動脈の中で最も頻度が高く，脳動脈瘤や脳動静脈奇形との合併した報告がみうけられるが^2,4,16)，加えて，対側の内頸動脈閉塞を伴った報告はない．今回，くも膜下出血で発症し，対側の内頸動脈閉塞を伴った多発性脳動脈瘤の手術例を経験したので報告する．

　The frequency of angiographic demonstration of persistent primitive trigeminal artery (PTA) is 0.06 to 0.6 %. It is well recognized that approximately 13.8 to 27.8 % of patients with PTA also have intracranial aneurysms. However their association with the contralateral occluded internal carotid artery (IC) has not been reported. We reported such an extremely rare case of PTA associated with multiple cerebral aneurysms and a contralateral occluded IC.

　A 61-year-old female suffered from sudden onset of severe headache with nausea and vomiting. When she was admitted to our hospital,she complained only of headache with nausea. Computed tomography de (monstrated a diffuse subarachnoid hemorrhage. Angiography showed a ruptured anterior communicating artery (Acom). Aneurysm and a left IC-PC large aneurysm with a broad neck. The angiogram also demonstrated a left PTA originating from the cavernous portion of the left internal carotid artery and ending at the midportion of the basilar artery and the contralateral occluded IC in the cervical portion. An operation was performed at day 3 using the left pterional approach,and the two aneurysms were successfuly clipped using the suction-decompression method. The patient was discharged with no neurological deficits.