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Neurological Surgery No Shinkei Geka Volume 47, Issue 9 （September 2019）

Neurological Surgery 脳神経外科 47巻9号（2019年9月発行）

Japanese English

症例

後下小脳動脈延髄前部の窓形成に発生した紡錘状未破裂脳動脈瘤の稀な1例 A Rare Case of an Unruptured Fusiform Aneurysm Arising from the Lateral Limb of the Fenestration of the Anterior Medullary Segment of the Posterior Inferior Cerebellar Artery 中村光流 ^1,3 , 江端由穂 ¹ , 日宇健 ² , 近松元気 ^1,4 , 塩崎絵理 ^1,4 , 森塚倫也 ² , 川原一郎 ² , 小野智憲 ² , 原口渉 ² , 牛島隆二郎 ² , 堤圭介 ² Hikaru NAKAMURA ^1,3 , Yuho EBATA ¹ , Takeshi HIU ² , Genki CHIKAMATSU ^1,4 , Eri SHIOZAKI ^1,4 , Tomoya MORITSUKA ² , 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長崎県島原病院脳神経外科 ⁴長崎大学病院脳神経外科 ¹Residency Program, Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center ²Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center ³Department of Neurosurgery, Nagasaki Prefecture Shimabara Hospital ⁴Department of Neurosurgery, Nagasaki University Hospital キーワード： posterior inferior cerebellar artery fenestration , unruptured aneurysm , primitive lateral vertebrobasilar anastomosis , primitive plexiform anastomosis , twig-like posterior inferior cerebellar artery Keyword: posterior inferior cerebellar artery fenestration , unruptured aneurysm , primitive lateral vertebrobasilar anastomosis , primitive plexiform anastomosis , twig-like posterior inferior cerebellar artery pp.991-997

発行日 2019年9月10日 Published Date 2019/9/10

DOI https://doi.org/10.11477/mf.1436204059

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　後下小脳動脈（posterior inferior cerebellar artery：PICA）における窓形成の報告は極めて少ない^10,12,15,17)．今回われわれは，PICA延髄前部（anterior medullary segment：AMS）の窓形成から発生した紡錘状未破裂脳動脈瘤の稀な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 fenestration of the posterior inferior cerebellar artery（PICA）with an aneurysm at the fenestrated portion.

　A 60-year-old man with a medical history of hemophilia was referred to our hospital for further examination of unruptured aneurysms at the left PICA and vertebral artery（VA）that were incidentally discovered by computed tomography angiography 5 years ago during an examination of spontaneous intracerebral hemorrhage. A 3D-rotational angiography revealed a fenestration（4.7×1.4mm）in the anterior medullary segment of the left PICA associated with an unruptured fusiform aneurysm（7.2×6.1mm）arising from the entire lateral limb of the fenestrated segment. The left VA aneurysm had a wide neck（7.2×6.8mm）and was located at the portion just distal to the bifurcation of the left PICA.

　The patient requested conservative management of both aneurysms because no significant change in the size or shape of either had been observed during the last 5 years.

　An extensive review of the literature revealed that nine cases of PICA fenestration have been reported. Among these, detailed medical records were described in seven cases, and an aneurysm at the fenestrated artery had been detected in only 2 cases. To our knowledge, this is the first report of a PICA fenestration associated with an unruptured aneurysm at the fenestrated segment.

　Embryologically, the PICA fenestration may represent a remnant of plexiform arterial channels between the primitive VA and primitive lateral vertebrobasilar anastomosis.