雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 47, Issue 6 （June 2019）

Neurological Surgery 脳神経外科 47巻6号（2019年6月発行）

Japanese English

症例

破裂末梢性後下小脳動脈瘤（cortical segment）の2例 Ruptured Aneurysms on the Cortical Segment of the Distal Posterior Inferior Cerebellar Artery:A Report of Two Cases and a Literature Review 渡邉瑞也 ¹ , 井口整 ¹ , 川村海渡 ¹ , 藤田修英 ¹ , 上野英明 ¹ , 中尾保秋 ¹ , 山本拓史 ¹ , 和田了 ² Mitsuya WATANABE ¹ , Sei INOKUCHI ¹ , Kaito KAWAMURA ¹ , Naohide FUJITA ¹ , Hideaki UENO ¹ , Yasuaki NAKAO ¹ , Takuji YAMAMOTO ¹ , Ryo WADA ² ¹順天堂大学医学部附属静岡病院脳神経外科 ²順天堂大学医学部附属静岡病院病理診断科 ¹Department of Neurosurgery, Juntendo University Shizuoka Hospital ²Department of Clinical Pathology, Juntendo University Shizuoka Hospital キーワード： posterior inferior cerebellar artery , PICA , cerebral aneurysm , subarachnoid hemorrhage , SAH Keyword: posterior inferior cerebellar artery , PICA , cerebral aneurysm , subarachnoid hemorrhage , SAH pp.673-681

発行日 2019年6月10日 Published Date 2019/6/10

DOI https://doi.org/10.11477/mf.1436204003

PDF(2308KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference

Ⅰ．はじめに

　後下小脳動脈瘤（posterior inferior cerebellar artery aneurysm：PICA AN）は全脳動脈瘤の0.49〜3%を占め¹⁸⁾，比較的稀なものと考えられる．その約2/3は椎骨動脈—後下小脳動脈分岐部動脈瘤（vertebral artery-posterior inferior cerebellar artery aneurysm：VA-PICA AN）であり^5,12)，さらにその末梢に生じた後下小脳動脈瘤（distal PICA AN）は少ない．加えて，distal PICA ANの発生部位は解剖学的特徴から5つのsegmentに分類され¹³⁾，脳幹部への穿通枝の有無によって治療方法も異なる．今回われわれは，2例のcortical segmentに発生したdistal PICA ANの破裂例を経験したので，その臨床的特徴，診断と治療方法，予後について検討し，文献的考察を加えて報告する．

　Two unusual cases of ruptured distal posterior inferior cerebellar artery（PICA）aneurysm on the cortical segment were successfully treated with open surgery. A 76-year-old woman presented with a Hunt and Kosnik（H＆K）grade II Subarachnoid hemorrhage（SAH). CT showed a slight SAH in the cisterna magna and around the vermis, and fourth intraventricular hematoma. Cerebral angiography revealed an aneurysm on the cortical segment of the distal PICA. Intraoperative findings identified the aneurysm as fusiform. Trapping of the aneurysm was performed, and the indocyanine green angiography fiuding confirmed aneurysmal flow disappearance and good circulation in the cerebellar cortex. An 89-year-old woman presented with H＆K grade II SAH. CT revealed a thick SAH in the posterior cranial fossa, and third to fourth intraventricular hematoma with hydrocephalus. Cerebral angiography revealed an aneurysm on the cortical segment of the distal PICA. Intraoperative findings showed that the aneurysm was fusiform. Trapping and resection of the aneurysm were performed. Thirteen previous cases of aneurysms on the cortical segment of the distal PICA have been reported. Distal PICA aneurysms apparently show rebleeding more frequently than do aneurysms at other locations, so immediate direct surgery is necessary to avoid rebleeding. After proximal ligation or trapping of the aneurysm, indocyanine green angiography is useful to determine the need for revascularization.