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Neurological Surgery No Shinkei Geka Volume 46, Issue 10 （October 2018）

Neurological Surgery 脳神経外科 46巻10号（2018年10月発行）

Japanese English

症例

Duplicate originと考えられる中大脳動脈起始部に発生した未破裂脳動脈瘤の1例 Unruptured Aneurysm Arising from the Proximal End of the Duplicate Origin of the Middle Cerebral Artery 平山航輔 ^1,2 , 中村光流 ¹ , 吉村正太 ^1,2 , 大園恵介 ¹ , 福田雄高 ^1,3 , 日宇健 ¹ , 川原一郎 ¹ , 小野智憲 ¹ , 原口渉 ¹ , 牛島隆二郎 ¹ , 戸田啓介 ^1,4 , 堤圭介 ¹ Kosuke HIRAYAMA ^1,2 , Hikaru NAKAMURA ¹ , Shota YOSHIMURA ^1,2 , Keisuke OZONO ¹ , Yutaka FUKUDA ^1,3 , Takeshi HIU ¹ , Ichiro KAWAHARA ¹ , Tomonori ONO ¹ , Wataru HARAGUCHI ¹ , Ryujiro USHIJIMA ¹ , Keisuke TODA ^1,4 , Keisuke TSUTSUMI ¹ ¹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 ²長崎県島原病院脳神経外科 ³福田脳神経外科 ⁴独立行政法人国立病院機構長崎川棚医療センター脳神経外科 ¹Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center ²Department of Neurosurgery, Nagasaki Prefecture Shimabara Hospital ³Fukuda Neurosurgical Clinic ⁴Department of Neurosurgery, National Hospital Organization Nagasaki Kawatana Medical Center キーワード： duplicate origin of the middle cerebral artery , unruptured aneurysm , proximal M1 fenestration , supraclinoid internal carotid artery fenestration , duplicate origin of the anterior cerebral artery Keyword: duplicate origin of the middle cerebral artery , unruptured aneurysm , proximal M1 fenestration , supraclinoid internal carotid artery fenestration , duplicate origin of the anterior cerebral artery pp.901-909

発行日 2018年10月10日 Published Date 2018/10/10

DOI https://doi.org/10.11477/mf.1436203837

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　近年，中大脳動脈（middle cerebral artery：MCA）の破格のなかで，2本のMCAが内頚動脈（internal carotid artery：ICA）終末部から別々に起始し，その後早期に癒合してリング状の形態を呈する構造について，MCAの窓形成とは異なる破格として，“duplicate origin of the MCA（DO-MCA）”という新たな診断名が提唱されている²⁵⁾．今回われわれは，DO-MCAと考えられる破格血管の起始部に発生した未破裂脳動脈瘤の1例を経験したため，文献的考察を加えて報告する．

　We report a rare case of an unruptured aneurysm arising from the junction between the internal carotid artery（ICA）and duplicate origin of the middle cerebral artery（MCA).

　A 49-year-old man who presented with vertigo was admitted to our hospital. Subsequent MR and CT angiograms revealed an incidental aneurysm arising from the proximal end of the duplicate origin of the left MCA. He underwent clipping via the distal transsylvian approach. The aneurysm projected to the posterior direction and several perforators from the two M1 segments were attached to the neck of the aneurysm, which made neck dissection very difficult. Approaching the space from the posterior/lateral direction to reach the M1 segment, the aneurysm neck was successfully dissected and clipped without sacrificing any perforators or stenosis of parent vessels. The postoperative course was uneventful, and the patient was discharged within 2 weeks.

　Duplicate origin of the MCA has been confused with a fenestration of the proximal M1 segment or terminal segment of the ICA. In this condition, two MCA branches arise separately from the terminal segment of the ICA and fuse early to form an arterial ring at the proximal M1 segment. An aneurysm originating from this anomaly has never been described. However, some aneurysms associated with this type of origin may have incorrectly been reported as those associated with proximal MCA or terminal ICA fenestrations. We summarize the cases that are similar to our case of duplicate origin of the MCA with an aneurysm, and discuss the precise diagnosis and significant intraoperative problems that were described in the literature.