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Neurological Surgery No Shinkei Geka Volume 45, Issue 10 （October 2017）

Neurological Surgery 脳神経外科 45巻10号（2017年10月発行）

Japanese English

症例

Azygos anterior cerebral artery脳梁下部（A2）のinfundibular dilatationに新生した多発性（破裂/未破裂）微小脳動脈瘤の1例 A Rare Case of Ruptured/Unruptured Miniature Aneurysms Originating from the Infundibular Dilatation of the Callosomarginal Artery, Branching from the Infracallosal（A2）Segment of the Azygos Anterior Cerebral Artery 吉村正太 ^1,2 , 杣川知香 ^1,2 , 佐藤慧 ² , 福田雄高 ^2,3 , 日宇健 ² , 小野智憲 ² , 牛島隆二郎 ² , 戸田啓介 ² , 堤圭介 ² Shota YOSHIMURA ^1,2 , Chika SOMAGAWA ^1,2 , Kei SATOH ² , Yutaka FUKUDA ^2,3 , Takeshi HIU ² , Tomonori ONO ² , Ryujiro USHIJIMA ² , Keisuke TODA ² , Keisuke TSUTSUMI ² ¹独立行政法人国立病院機構長崎医療センター初期研修プログラム ²独立行政法人国立病院機構長崎医療センター脳神経外科 ³北九州市立八幡病院脳神経外科 ¹Department of Neurosurgery（Residency Program), National Hospital Organization, Nagasaki Medical Center ²Department of Neurosurgery, National Hospital Organization, Nagasaki Medical Center ³Department of Neurosurgery, Kitakyushu Municipal Yahata Hospital キーワード： azygos anterior cerebral artery , infundibular dilatation , de novo aneurysm , ruptured aneurysm , subarachnoid hemorrhage Keyword: azygos anterior cerebral artery , infundibular dilatation , de novo aneurysm , ruptured aneurysm , subarachnoid hemorrhage pp.897-904

発行日 2017年10月10日 Published Date 2017/10/10

DOI https://doi.org/10.11477/mf.1436203615

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参考文献 Reference

Ⅰ．はじめに

　Azygos anterior cerebral artery（AACA）に発生する脳動脈瘤の多くは遠位端分岐部にみられ，近位端や脳梁下部（A2）の報告は少ない^14,56)．Infundibular dilatation（ID）は一般に正常の解剖学的破格とされるが，稀にそれ自体からのくも膜下出血（subarachnoid hemorrhage：SAH)⁷⁾や脳動脈瘤の発生¹²⁾も報告されている．今回われわれは，AACAのA2部に起始するcallosomarginal artery（CMA）のIDから，短期間に2個の微小脳動脈瘤が互いに逆方向へ新生し，一方の破裂によりSAHを発症したと考えられる極めて稀な症例を経験した．文献的考察を加えて報告する．

　We report the first case of two de novo miniature aneurysms（ruptured/unruptured）emerging from the infundibular dilatation（ID）of the callosomarginal artery, which branches from the infracallosal（A2）segment of the azygos anterior cerebral artery（AACA), in a 36-year-old woman.

　The patient had previously been diagnosed with a miniature, unruptured aneurysm, occurring in the A2 segment of the AACA, detected by CT angiography（CTA）at another hospital two years ago, and had been followed up with MR angiography（MRA）every 6 months. Three months after the final check-up with MRA, which did not indicate a significant change in the aneurysm, the patient presented with subarachnoid hemorrhage. Subsequent CTA and digital subtraction angiograms revealed that the right callosomarginal artery, originating from the apex of the aneurysmal bulge, had a maximal diameter of 3mm, indicating an ID of the artery. Additionally, two miniature bleb-like aneurysms emerged from the ID, projecting in opposite directions:one projecting to the right-posterior/superior direction and the other to the left-anterior/inferior direction. Both aneurysms were successfully clipped via a right pterional approach with partial resection of the gyrus rectus, and the right-projecting aneurysm was confirmed to be ruptured during surgery.

　In the current report, we review previously reported cases of AACA with aneurysms, and discuss their clinical characteristics, and the possible mechanisms underlying the formation of the ID and de novo aneurysms in this extremely rare case.