椎骨脳底動脈合流部の巨大，紡錘形および解離性動脈瘤—特に症候と非根治手術の予後

Giant, Fusiform and Dissecting Aneurysms at the Vertebro-Basilar Junction: Report of five cases and their linicopathophysiolo-gical aspects

I．はじめに

　椎骨動脈—後下小脳動脈（VA-PICA）分岐部や，椎骨動脈—脳底動脈合流部（VA-B junction）には巨大あるいは紡錘形，ときには，解離性動脈瘤が比較的よく発生するが^17），解剖学的位置，手術手技の困難さ，瘤の複雑な病態などから根治手術不能となる例がある．今回われわれは種々の事情で手術を施行しなかったり，流入動脈の閉塞を行ったこれら動脈瘤5症例を経験したが，その症候，手術を考慮する上で問題となる動脈瘤の病態，予後などについて検討したので，若干の文献的考察を加えて報告する．

Five cases of giant, fusiform, and dissecting aneurysms of the vertebro-basilar junction, in whichdirect surgical treatment was not feasible, are reported. Their initial symptoms were as follows : 3 subarach-noid hemorrhages (2 fusiform aneurysms, 1 giant aneurysm) , 1 mass sign (giant aneurysm) , and 1 ische-mic sign (dissecting aneurysm) . In two patients, one with a giant and one with a dissecting aneurysm, preoperative proximal vertebral occlusion was carried out by inflated balloon for 30 to 100 minutes, under observation of clinical sings and measurement of distal arterial pressure.