出血発症成人片側もやもや病に多発性未破裂脳動脈瘤を伴った1例

Hemorrhagic Adult Unilateral Moyamoya Disease with Multiple Unruptured Intracranial Aneurysms:A Case Report

Ⅰ．はじめに

　片側もやもや病に脳動脈瘤を伴う場合，発症形式によって病態は大きく異なるため，その治療方針には一定の見解がないのが現状である．今回われわれは，10年以上前から未破裂前交通動脈（anterior communicating artery：Acom A）動脈瘤と片側もやもや病を指摘され，脳出血で発症した症例に対して慢性期に血行再建術と動脈瘤頚部クリッピング術を一期的に行った．その治療適応および治療法，治療時期に関して文献的考察を含めて報告する．

　Adult unilateral moyamoya disease with intracranial aneurysm is frequently reported in the literature, but there is much variation in its treatment. In this case report, we describe the time course and treatment regimen of a patient with moyamoya disease and review the literature regarding moyamoya disease with intracranial aneurysm.

　A 64-year-old man had untreated intracranial aneurysm and unilateral moyamoya disease for 10 years. He presented with sudden-onset right hemiparesis and aphasia due to a subcortical hemorrhage. He was admitted to the local neurosurgical unit, and upon resolution of symptoms, he was admitted to our hospital. A cerebral angiogram revealed the champagne bottleneck sign of the left carotid artery and obliteration of the top of the left intracranial carotid artery with a moyamoya phenomenon. Two unruptured intracranial aneurysms were identified in the anterior communicating artery（Acom A）and the right intracranial carotid artery（C3). We performed superficial temporal artery-middle cerebral artery anastomosis followed by aneurysmal neck clipping of the Acom A aneurysm. Postoperative imaging showed no new ischemic damage and improved cerebral blood flow. Although the patient experienced temporal worsening of aphasia, his function recovered a few months later and he was able to resume his normal daily life activities.

　The combination of direct bypass surgery and aneurysmal neck clipping might be a therapeutic option for hemorrhagic unilateral moyamoya disease with unruptured intracranial aneurysm.