頭蓋内ステントを併用することで血管内治療により治療し得た前大脳動脈窓形成に合併した未破裂脳動脈瘤の1例

Unruptured Cerebral Aneurysm Associated with Fenestration of the Anterior Cerebral Artery Successfully Treated with Coil Embolization Using an Intracranial Stent:A Case Report

Ⅰ．はじめに

　近年，窓形成に合併した脳動脈瘤に対して血管内治療が有用であった報告が散見されるようになってきた^{3,5,6,7,10,11)}．今回われわれは，前大脳動脈水平部（A1）の窓形成に合併した未破裂脳動脈瘤に対して，頭蓋内ステントを併用したコイル塞栓術にて治療し得た症例を経験した．渉猟し得た限りでは，頭蓋内ステントを併用した症例は報告がなく，非常に稀な治療例であり，文献的考察を含めて報告する．

　Recent sporadic reports have described successful endovascular treatment of cerebral aneurysms associated with fenestration. We experienced an unruptured cerebral aneurysm case, with fenestration of the horizontal portion of the anterior cerebral artery that was successfully treated with coil embolization using an intracranial stent. An 80-year-old man presented with a chief complaint of gait disorder. Magnetic resonance imaging showed an incidental unruptured aneurysm. Three-dimensional digital subtraction angiography revealed a cerebral aneurysm associated with fenestration of the horizontal portion of the anterior cerebral artery. Endovascular surgery was performed at the patient's request. Conservation of the fenestrated vessels and perforators is important in the treatment of cerebral aneurysm associated with fenestration. Intracranial stents are reportedly useful for conserving not only parent vessels but also their perforators. In the present case, no postoperative perforator damage occurred. An endovascular approach is a potential treatment option with full evaluation of the relationship between the aneurysm and fenestrated vessels.