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Neurological Surgery No Shinkei Geka Volume 47, Issue 5 （May 2019）

Neurological Surgery 脳神経外科 47巻5号（2019年5月発行）

Japanese English

症例

前大脳動脈脳梁下部（A2）の窓形成近位端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 Infracallosal Segment（A2）of the Anterior Cerebral Artery 近松元気 ^1,2 , 日宇健 ² , 塩崎絵理 ^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 Genki CHIKAMATSU ^1,2 , Takeshi HIU ² , Eri SHIOZAKI ^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国立病院機構長崎医療センター脳神経外科 ³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： anterior cerebral artery fenestration , infracallosal segment , unruptured aneurysm , embryology , primitive plexiform anastomosis Keyword: anterior cerebral artery fenestration , infracallosal segment , unruptured aneurysm , embryology , primitive plexiform anastomosis pp.565-572

発行日 2019年5月10日 Published Date 2019/5/10

DOI https://doi.org/10.11477/mf.1436203983

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　前大脳動脈（anterior cerebral artery：ACA）系の窓形成は，前交通動脈（anterior communicating artery：ACoA）以外では水平部（A1）に好発し^1,7)，脳梁下部（A2）についての報告は少ない⁴⁾．今回われわれは，A2近位端の窓形成部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 infracallosal（A2）segment of the right anterior cerebral artery（ACA）associated with an unruptured aneurysm at the proximal end of the fenestrated portion.

　A 70-year-old man was referred to our hospital for further examination and treatment of unruptured aneurysms at the A1/A2 junction of the right ACA and the distal end of the right vertebral artery that were incidentally detected on MR angiography. CT angiography and 3D-rotational angiography revealed a fenestration in the proximal A2 segment of the right ACA with a small（3.6×3.8mm）aneurysm arising from the proximal end of the fenestration. The dome of the aneurysm projected to the left anterior/inferior direction. He underwent aneurysm neck clipping surgery via the right pterional approach without complications, while the vertebral artery aneurysm was managed conservatively.

　An extensive review of the literature revealed that only a small number of cases of A2 fenestration have been reported to date. To our knowledge, this is the first report of an A2 fenestration associated with an aneurysm at the fenestrated segment.

　Embryologically, the A2 fenestration may represent a remnant of plexiform arterial channels that constitute the primitive ACA system including the primitive olfactory artery, median artery of the corpus callosum and anterior communicating plexus.