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Neurological Surgery No Shinkei Geka Volume 48, Issue 6 （June 2020）

Neurological Surgery 脳神経外科 48巻6号（2020年6月発行）

Japanese English

症例

Duplicate origin of the middle cerebral arteryに発生した未破裂脳動脈瘤の1例 A Case of Unruptured Cerebral Aneurysm Arising from Duplicate Origin of the Middle Cerebral Artery 岩田牧子 ¹ , 川口正二郎 ¹ , 間中浩 ² Makiko IWATA ¹ , Shojiro KAWAGUCHI ¹ , Hiroshi MANAKA ² ¹総生会麻生総合病院脳神経外科 ²横浜市立大学附属市民総合医療センター脳神経外科 ¹Department of Neurosurgery, Asao General Hospital ²Department of Neurosurgery, Yokohama City University Medical Center キーワード： anomaly of middle cerebral artery , duplicate origin of the middle cerebral artery , cerebral aneurysm , coil embolization Keyword: anomaly of middle cerebral artery , duplicate origin of the middle cerebral artery , cerebral aneurysm , coil embolization pp.515-520

発行日 2020年6月10日 Published Date 2020/6/10

DOI https://doi.org/10.11477/mf.1436204221

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　中大脳動脈（middle cerebral artery：MCA）の破格には，副中大脳動脈（accessory MCA），重複中大脳動脈（duplicated MCA：DMCA），窓形成（fenestration of the MCA），twig-like MCAがある⁶⁾．また，fenestration of the MCAとして報告されてきたもののうち，内頚動脈より分岐しMCA水平部に合流するものをduplicate origin of the MCAとして区別するべきとする報告がある⁵⁾．

　今回われわれは，duplicate origin of the MCAに合併した未破裂脳動脈瘤の1例を経験したので，文献的考察を交えて報告する．

　We experienced a case of an unruptured cerebral aneurysm arising from a duplicate origin of the middle cerebral artery（MCA). Initially, we diagnosed the condition as an unruptured aneurysm arising from the internal carotid artery on three-dimensional computed tomography;neck clipping was attempted. However, an unidentified vessel was found around the aneurysmal neck, which could not be easily separated from the aneurysm, making neck clipping difficult. Thus, we only completed coating of the aneurysm without neck clipping. Postoperatively, cerebral angiography showed that the unidentified vessel originated from the internal carotid artery and fused with the MCA horizontal segment. We recognized that the identified vessel was a duplicate origin of the MCA. Few reports on the treatment of an aneurysm arising from a duplicate origin of the MCA are available;there has been no discussion on whether this vessel can be occluded. We assumed that occlusion of the proximal end of the duplicate origin of the MCA together with the aneurysm was unlikely to cause ischemia as the duplicate origin of the MCA fuse with MCA. Coil embolization was performed for the aneurysm, and the duplicate origin was unexpectedly preserved immediately after coil embolization. However, it was not enhanced on cerebral angiography performed after several months, and no cerebral infarction was noted on magnetic resonance imaging. If preservation of the duplicate origin of the MCA is difficult, occlusion of the aneurysm together with the proximal end of the duplicate origin of the MCA can be considered as a surgical strategy.