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Neurological Surgery No Shinkei Geka Volume 48, Issue 11 （November 2020）

Neurological Surgery 脳神経外科 48巻11号（2020年11月発行）

Japanese English

症例

前交通動脈におけるkissing mirror aneurysmsの1例 Kissing Mirror Aneurysms of the Anterior Communicating Artery. A Case Report 内田和希 ¹ , 牛越聡 ² , 安田宏 ³ Kazuki UCHIDA ¹ , Satoshi USHIKOSHI ² , Hiroshi YASUDA ³ ¹手稲渓仁会病院脳神経外科 ²柏葉脳神経外科病院脳神経外科 ³札幌麻生脳神経外科病院脳神経外科 ¹Department of Neurosurgery, Teine Keijinkai Hospital ²Department of Neurosuegery, Kashiwaba Neurosurgical Hospital ³Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital キーワード： kissing aneurysms , mirror aneurysms , anterior communicating artery , subarachnoid hemorrhage , coil embolization Keyword: kissing aneurysms , mirror aneurysms , anterior communicating artery , subarachnoid hemorrhage , coil embolization pp.1073-1078

発行日 2020年11月10日 Published Date 2020/11/10

DOI https://doi.org/10.11477/mf.1436204322

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参考文献 Reference

Ⅰ．はじめに

　Kissing aneurysmsとは，異なる部位から発生した2つの脳動脈瘤の壁が接している状態と定義されている．稀な状態であり，0.2%の頻度と報告されている¹²⁾．Mirror aneurysmsとは，両側頭蓋内動脈の同じ場所に左右対称性にある脳動脈瘤であり，2〜12%の頻度と報告されている^2,6,8,9)．これら両方を満たすkissing mirror aneurysmsは非常に稀である^7,10,11)．術前に診断することはしばしば困難となるが，治療方針を決定する上でこの病態を知っておくことは非常に重要である．

　われわれは，破裂前交通動脈瘤に対しコイル塞栓術を行ったが，その後再破裂したため開頭脳動脈瘤クリッピング術を行い，kissing mirror aneurysmsであったと認識した症例を経験したので報告する．

　Kissing aneurysms are defined as two adjacent aneurysms arising from identical or different arteries with separate origins and partially adherent walls. Mirror aneurysms are defined as intracranial aneurysms located in similar positions bilaterally on the parent arteries. Both kissing and mirror aneurysms at the anterior communicating artery（AcomA）are rare. We report a case of subarachnoid hemorrhage（SAH）due to ruptured kissing mirror aneurysms of the AcomA.

　An 80-year-old woman was admitted to our hospital with a sudden headache and vomiting. CT revealed diffuse SAH. Digital subtraction arteriography（DSA）revealed an aneurysm at the right A1-A2 junction of the AcomA. Hence, coil embolization was performed. On day 14 following embolization, rebleeding occurred. DSA revealed complete occlusion of the aneurysm at the right A1-A2 junction. However, left carotid angiography revealed an aneurysm at the left A1-A2 junction. We did not understand the anatomical construction of the aneurysms;therefore, we selected microsurgical treatment to clip the AcomA aneurysm using an interhemispheric approach. The left A1-A2 junctional aneurysm was anterior to the right A1-A2 junctional aneurysm, which was coil embolized. We detected the left A1-A2 junctional aneurysm as a ruptured aneurysm. The two aneurysms were adhered to each other. After dissection to expose the aneurysmal neck, the left A1-A2 junctional aneurysm was clipped.

　Kissing mirror aneurysms are difficult to diagnose before treatment. Knowledge and suspicion of the occurrence of kissing mirror aneurysms in the AcomA are important.