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Neurological Surgery No Shinkei Geka Volume 19, Issue 9 （September 1991）

Neurological Surgery 脳神経外科 19巻9号（1991年9月発行）

Japanese English

症例

Infraoptic Course of ACA with Aneurysmの1例 A Case Showing the Infraoptic Course of the Anterior Cerebral Artery Associated with Anterior Cerebral Artery Aneurysm 竹下幹彦 ¹ , 久保長生 ¹ , 恩田英明 ¹ , 長尾建樹 ¹ , 川俣貴一 ¹ , 内布英昭 ¹ , 仁田仁恵 ¹ , 山村一仁 ¹ , 加川瑞夫 ¹ Mikihiko TAKESHITA ¹ , Osami KUBO ¹ , Hideaki ONDA ¹ , Takeki NAGAO ¹ , Takakazu KAWAMATA ¹ , Hideaki UCHINUNO ¹ , Masae NITTA ¹ , Kazuhito YAMAMURA ¹ , Mizuo KAGAWA ¹ ¹東京女子医科大学脳神経センター脳神経外科 ¹Department of Neurosurgery, Neurological Institute Tokyo Women's Medical College キーワード： Vascular anomaly , Anterior cerebral artery , Internal carotid artery , Cerebral aneurysm , Optic nerve Keyword: Vascular anomaly , Anterior cerebral artery , Internal carotid artery , Cerebral aneurysm , Optic nerve pp.871-876

発行日 1991年9月10日 Published Date 1991/9/10

DOI https://doi.org/10.11477/mf.1436900325

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Abstract 文献概要
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I．はじめに

　内頸動脈が海綿静脈洞内を通過し，硬膜を貫いた直後，ほぼ眼動脈が分岐する付近で，内頸動脈の内側から分岐し，視神経の下方から視交叉の前方を上行し前交通動脈部に血管奇形は，非常に稀で，Robinson^18）の剖検での報告“An unusual human anterior cerebral artery”以来，文献上，われわれが渉猟し得た限りわずか29例^{1-16,18-25）}である．その名称も報告者により様々である．しかしながら，この異常血管の起源についても今だ定説は確立されていない．今回著者らは，上記異常血管が前交通動脈部へ達し脳動脈瘤を形成し，また椎骨動脈の窓形成，後頭動脈の内頸動脈起源を伴った稀な血管奇形の1症例を経験したので，若干の文献的考察を加え報告する．

Abstract

A ruptured anterior cerebral artery aneurysm with anomalous right infraoptic course of the anterior cere-bral artery (ACA) was reported.

A 40-year old male was admitted because of SAH episode, and computerized tomography (CT) on the day of admission revealed hemorrhage in both Sylvian and interhemispheric fissures. Four-vessel angiography was performed on the same day. A saccular aneurysm was demonstrated in the region of the anterior com-municating artery (ACoA) , and anomalous artery, which originated from the intradural right carotid artery at the level of the right ophthalmic artery was found to be running medially and superiorly. It sup-plied the bilateral callosomarginal arteries and the un-paired pericallosal artery. The fenestration of the ver-tebral artery, duplication of bilateral superior cerebellar arteries, and an occipital artery arising from the right internal carotid artery at the C3 level were found. Surgery was performed on the first day of admission, and the anterior interhemispheric approach was selected. The anomalous branch of the right ICA ran beneath the right optic nerve, ascended between the op-tic nerves, and supplied the ACoA system. The left hypoplastic A1 segment entered the ACoA. However, the right A1 segment could not be found. The aneurys-mal neck, situated between the bilateral callosomarginal arteries and the unpaired pericallosal artery, was clip-ped with Sugitas curved clip. The postoperative course was uneventful and a follow-up angiograph revealed successful obliteration of the aneurysm.