前交通動脈瘤クリッピングに伴う対側Heubner artery閉塞の1例

Contralateral Infarction in the Territory of the Recurrent Artery of Heubner after Anterior Communicating Artery Aneurysm Surgery

Ⅰ．はじめに

　Pterional approachによる前交通動脈瘤の手術では，動脈瘤に到達する途中で術野に現れるHeubner arteryを損傷しないよう注意を要するが，対側のHeubner arteryを意識することはほとんどないと思われる．今回，動脈瘤先端が視交叉に癒着した下向き未破裂前交通動脈瘤のクリッピング術において，クリップにより対側Heubner arteryの閉塞を来し，尾状核頭部から被殻に至る脳梗塞を生じた症例を経験したので報告する．

　We report a rare case of postoperative infarction in the territory of the contralateral recurrent artery of Heubner （RAH） after surgery. A 67-year-old male was treated by the right pterional approach with clipping surgery for an unruptured anterior communicating artery aneurysm projecting inferiorly. Postoperative CT scan revealed infarctions in the left caudate head and the left putamen. In this case, the RAH probably coursed inferiorly to the A1 segment and was behind the aneurysmal dome. These infarctions were considered to result from occlusion of the left RAH because the clip blade extended too far beyond the aneurysmal neck.