内頚動脈閉塞術にて治療した外傷性錐体部内頚動脈瘤の1例

A Case of Traumatic Petrous Portion Internal Carotid Artery Aneurysm Treated by Endovascular Parent Artery Occlusion

Ⅰ．は じ め に

　外傷性頭蓋内動脈瘤は非常に稀な疾患であり，全脳動脈瘤の0.15～0.4％といわれている⁴⁾．この早期発見は困難であり，臨床所見や治療も囊状動脈瘤とは異なる．今回われわれは，重症頭部外傷により発症した錐体部の外傷性内頚動脈瘤の1例を経験した．また，併発した周囲の出血，外傷性髄液漏により動脈瘤の発見が遅れ，注意が必要と思われたため，文献的考察を加えて報告する．

　Traumatic aneurysms are rare lesions. They differ markedly from saccular aneurysms in their clinical presentation and therapy. Early diagnosis of traumatic aneurysms is usually difficult. A 52-year-old female presented with massive epistaxis and ear bleeding caused by a traffic accident. On admission, her consciousness level was 7 points of the Glasgow coma scale. Computed tomography revealed hematoma in the sphenoid sinus and fractures in the right petrous bone, and right acute subdural hematoma.

　7 years after trauma, she presented ear bleeding. Cerebral angiography showed a giant traumatic aneurysm at the petrous segment of the right internal carotid artery. Test occlusion of the right internal carotid artery was performed and was well tolerated without development of focal neurological deficits, so the right internal carotid artery was occluded using endovascular techniques. We recommend that more attention be paid to the traumatic aneurysm of the C4 to C5 portion when patients with skull base fracture are diagnosed.