巨大内頸動脈瘤の1直達手術治験例—海綿静脈洞と内頸動脈との解剖学的関係を背景に

A Giant Aneurysm of the Internal Carotid Artery Treated by Intracranial Direct Surgery:With a Special Reference to the Anatomical Relationship between the Cavernous Sinus and the Internal Carotid Artery

Ⅰ．はじめに

　内頸動脈は頸動脈管canalis caroticusより頭蓋内に入り，小翼突起processus alae ptrvaeの内方，視束管の下で硬膜内に入る．この内頸動脈の頭蓋内，硬膜外の部分は，pars intracanalicularis，pars ganglionalis，pars cavernosa，genu anteriusと区分されている．

　内頸動脈のpars cavernosa，genu anteriusの部分には動脈瘤が好発し，また海綿静脈洞との間にしばしば瘻を形成し，脳神経外科の臨床上関心のもたれるところである．しかし，内頸動脈と海綿静脈洞との解剖学的相互関係については，1964年Parkinson^21）の報告したものがそのまま認められ，KrayenbühlらのCerebral Angiography^14）をはじめ，多くの著者がそのまま引用して今日に至っている．

There have been a few reports about intracranial giant aneurysms treated by intracranial direct approaches. Especially, for giant aneurysms of the internal carotidartery, direct operation has been thought to be difficult to perform because of the anatomical particularity and the danger of rupture during surgery. So the cervical carotid ligation has frequently been indicated. However, the carotid ligation does not relieve the symptoms caused by the giant aneurysm as an "intracranial mass lesion".