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Neurological Surgery No Shinkei Geka Volume 47, Issue 2 （February 2019）

Neurological Surgery 脳神経外科 47巻2号（2019年2月発行）

Japanese English

症例

内頚動脈海綿静脈洞部の窓形成近位に発生した未破裂脳動脈瘤の稀な1例 A Rare Case of an Unruptured Aneurysm Arising from the Proximal End of the Fenestration of the Cavernous Segment of the Internal Carotid Artery 塩崎絵理 ^1,2 , 日宇健 ² , 近松元気 ^1,2 , 中村光流 ^1,2 , 大園恵介 ² , 本田和也 ³ , 森塚倫也 ³ , 川原一郎 ² , 小野智憲 ² , 原口渉 ² , 牛島隆二郎 ² , 堤圭介 ² Eri SHIOZAKI ^1,2 , Takeshi HIU ² , Genki CHIKAMATSU ^1,2 , Hikaru NAKAMURA ^1,2 , Keisuke OZONO ² , Kazuya HONDA ³ , Tomoya MORITSUKA ³ , Ichiro KAWAHARA ² , Tomonori ONO ² , Wataru HARAGUCHI ² , Ryujiro USHIJIMA 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脳神経外科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独立行政法人国立病院機構長崎医療センター ¹Residency Program, Department of Neurosurgery, National Hospital Organization, Nagasaki Medical Center ²Department of Neurosurgery, National Hospital Organization, Nagasaki Medical Center ³National Hospital Organization, Nagasaki Medical Center キーワード： internal carotid artery fenestration , cavernous segment , unruptured aneurysm , embryology , primitive plexiform arterial channel Keyword: internal carotid artery fenestration , cavernous segment , unruptured aneurysm , embryology , primitive plexiform arterial channel pp.217-223

発行日 2019年2月10日 Published Date 2019/2/10

DOI https://doi.org/10.11477/mf.1436203921

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　内頚動脈（internal carotid artery：ICA）における窓形成の報告例は未だ少なく，その多くは頚部から錐体部ないし床上部に発生している^23,31,33)．今回われわれは，ICA海綿静脈洞部の窓形成に合併した未破裂脳動脈瘤の極めて稀な1例を経験したので，文献的考察を加えて報告する．

　We report an extremely rare case of a fenestration in the cavernous segment of the left internal carotid artery（ICA）associated with an unruptured aneurysm at the proximal end of the fenestrated portion.

　A 44-year-old woman with a dull headache was referred to our hospital for further evaluation of a suspected aneurysm in the right ICA on MR angiography（MRA). CT angiography and 3D-rotational angiography revealed no aneurysm in the right ICA;however, an intracavernous fenestration with an incidental aneurysm was observed in the left ICA. The aneurysm was small（5×3mm）with a wide neck arising from the origin of the ventral limb of the duplicated vessels, in association with a tiny bulge projecting medially. She requested conservative management and periodic follow-up with MRA. After 18 months, no structural change in the aneurysm was observed.

　To our knowledge, including our patient, only three cases of this type of ICA fenestration have been published, and this is the first report of an ICA fenestration with an unruptured aneurysm at the fenestrated segment. It is presently unknown whether the intracavernous fenestration has the potential to form an aneurysm within the proximal end of the duplicated segment, as reported in cases of supraclinoid ICA fenestrations.