Hardy術後に髄膜炎を合併し細菌性動脈瘤を生じた1例

A Case of Bacterial Aneurysm Following Hardy's Operation

I．はじめに

　細菌性脳動脈瘤は全動脈瘤の2.5％から4.5％といわれ稀なものである^12,20）．その原因についてはintravascu—lar originとextravascular originにわけられており，多くの症例は細菌性心内膜炎によるintravascular originである．著者らはHardy術後に化膿性髄膜炎を併発し，その後細菌性脳動脈瘤を発生した1例を経験した．そこで若干の文献的考察を加えてここに報告する．

Abstract

Intracranial mycotic aneurysm of extravascular origin is reported. A 64 year-old male developed headache and visual disturbance. Computed Tomography (CT) revealed high density mass lesion with contrast enhance-ment in the intra-and suprasellar lesion.

He was then admitted to our hospital under the dia-gnosis of pituitary adenoma. But he suddenly com-plained of headache and loss of vision during hospitali-zation. An emergency operation using the transsphenoi-dal approach was performed. The pathological diagno-sis was craniopharyngioma.

Postoperative radiation therapy was carried out using a tumor dose of 50Gy. Two months after the operation, he suffered from rhinorrhea and high fever. He was admitted again and treated with high doses of antibio-tics. Two weeks after admission, he suddenly lost con-sciousness. A CT scan revealed an aneurysm of the anterior temporal artery. Immediately, removal of the hematoma and resection of the aneurysm were per-formed.

Microscopic examination showed that inflammatory cells had infiltrated the aneurysmal wall, and lympho-cytes and plasma cells had gathered around the mi-croabscess.

This rare case is discussed with other related cases in the literature.