母血管温存を考慮して治療を行った高齢者未破裂囊状椎骨動脈瘤の1例

Treatment of Unruptured Saccular Vertebral Artery Aneurysm for Preservation of the Parent Artery for Advanced Age People: A Case Report

Ⅰ．はじめに

　椎骨動脈（vertebral artery：VA）─後下小脳動脈（posterior inferior cerebellar artery：PICA）分岐部の動脈瘤neck clippingの際には，母血管および穿通枝の狭窄・閉塞による虚血症状や，下位脳神経麻痺の併発に注意しなければならない．

　今回われわれは，高齢者で動脈瘤domeからPICAが分岐している未破裂囊状椎骨動脈瘤に対して，母血管を温存すべく後頭動脈（occipital artery：OA）-PICA bypassと瘤内コイル塞栓術を併用した治療を経験したので，文献的考察を加え報告する．

　A 79-year-old female was referred to our hospital presenting with occipital headache. Her unruptured aneurysm was incidentally found by magnetic resonance angiography. Three dimensional computed tomographic angiography showed a saccular aneurysm located at the junction of the left vertebral artery (VA) and posterior inferior cerebellar artery (PICA) that originated from the aneurysm itself. Firstly,surgical clipping of the left PICA just distal to the aneurysm and occipital artery (OA)-PICA bypass was carried out and,secondly,endovascular treatment was performed for preservation of the parent artery.