外傷性中硬膜動脈偽動脈瘤，硬膜動静脈瘻，同側慢性硬膜下血腫，対側硬膜下水腫，および非外傷性椎骨後頭動脈吻合の1合併例

A Surgical Case with Traumatic False Aneurysm, Arteriovenous Fistula of the Middle Meningeal Artery, Ipsilateral Chronic Subdural Hematoma and Contralateral Subdural Hydroma and Nontraumatic Vertebro-occipital Anastomosis

Ⅰ．はじめに

　頭蓋骨々折を伴う硬膜外血腫例では，脳血管撮影で造影剤の血管外漏出，硬膜動脈偽動脈瘤，硬膜動静脈瘻などのみられることがあると言われてきたが，実際には意外に稀なものである．

　われわれは，頭部外傷による頭蓋頭皮下破砕骨折を有する慢性期の患者に，脳血管撮影を行ったところ，中硬膜動脈偽動脈瘤および硬膜動静脈瘻を認め，更にその上患側の硬膜下血腫，対側の硬膜下水腫ならびに椎骨動脈—後頭動脈吻合をも合併した症例を経験したので，文献的考察を加えて報告する．

A 49-year-old man with traumatic false aneurysm, arteriovenous fistula of the middle meningeal artery, ipsilateral chronic subdural hematoma, contralateral subdural hydroma, and nontraumatic vertebrooccipital anastomosis was reported with a review of the literature.

Traumatic false aneurysm of the middle meningeal artery of 32 cases was already reported in the world, and traumatic arteriovenous fistula of the middle menin-geal artery was found in 47 cases, but combination of the both is very rare and only 6 including ours have been found in the literature.